The Addition of Continuous Intravenous Infusion of Ketorolac to a Patient-Controlled Analgetic Morphine Regime Reduced Postoperative Myocardial Ischemia in Patients Undergoing Elective Total Hip or Knee Arthroplasty
- 1 April 1997
- journal article
- clinical trial
- Published by Wolters Kluwer Health in Anesthesia & Analgesia
- Vol. 84 (4) , 715-722
- https://doi.org/10.1097/00000539-199704000-00003
Abstract
This double-blind randomized trial assessed the effect of adding an intravenous continuous infusion of ketorolac to a patient-controlled analgesia (PCA) morphine regimen on analgesia, heart rate, arterial blood pressure, and postoperative myocardial ischemia. Patients having elective total hip or knee replacement were randomized to receive ketorolac 30 mg bolus, followed by an infusion of 5 mg/h for 24 h or placebo. All patients had access to PCA morphine (20 microg/kg bolus, with a lockout of 6 min). Patients were monitored for pain visual analog scale, blood pressure, heart rate, and ST segment depression via a continuous Holter monitor. ST depression of 1 mm 60 ms after the J point was considered significant if it lasted more than 1 min. There was no difference in demographics, risk factors, or cardiac medications between the groups. Ketorolac-treated patients had significantly better pain control at 2, 6, and 24 h. There was significant morphine sparing at all times after 3 h. There was no difference in the number of ischemic events between the groups. The ischemic episodes of the patients who received ketorolac occurred at slower heart rates (97 +/- 15 vs 114 +/- 16 bpm, P = 0.001) than those of patients in the placebo group. The duration of ST depression was shorter in ketorolac-treated patients (24 +/- 35 vs 76 +/- 95 min, P < 0.05). All ST depressions were clinically silent. Logistic regression of factors predicting ischemia included the use of calcium channel blockers and low pain score. These results suggest that analgesia with ketorolac reduces the duration of ischemic episodes in the first 24 h postoperatively.Keywords
This publication has 29 references indexed in Scilit:
- Epidural morphine reduces the riskof postoperative myocardial ischaemia in patients with cardiac risk factorsCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 1993
- Silent myocardial ischemia monitoring predicts late as well as perioperative cardiac events in patients undergoing vascular surgeryJournal of Vascular Surgery, 1992
- Multicenter Study of General Anesthesia III. Predictors of Severe Perioperative Adverse OutcomesAnesthesiology, 1992
- Effects of Epidural Anesthesia and Analgesia on Coagulation and Outcome After Major Vascular SurgeryAnesthesia & Analgesia, 1991
- Association of Perioperative Myocardial Ischemia with Cardiac Morbidity and Mortality in Men Undergoing Noncardiac SurgeryNew England Journal of Medicine, 1990
- Multicenter Study of General Anesthesia. II. ResultsAnesthesiology, 1990
- Correlation between Preoperative Ischemia and Major Cardiac Events after Peripheral Vascular SurgeryNew England Journal of Medicine, 1989
- Epidural Anesthesia and Analgesia in High-risk Surgical PatientsAnesthesiology, 1987
- Complications associated with anaesthesiaa — prospective survey in FranceCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 1986
- A survey of 112,000 anaesthetics at one teaching hospital (1975–83)Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 1986