To review the use of continuous infusion (CI) nonsteroidal anti-inflammatory drugs (NSAIDs) as an alternative modality for pain control in surgical patient populations.
Methods:
A PubMed and MEDLINE search was conducted from 1964 through February 2016 using the following search terms alone or in combinations: continuous, infusion, nonsteroidal anti-inflammatory drug, diclofenac, ibuprofen, indomethacin, ketoprofen, ketorolac, and surgery. All English-language, prospective and retrospective, adult and pediatric studies evaluating intravenous or intramuscular CI NSAIDs for surgical pain were evaluated for inclusion in this review.
Results:
Twenty four prospective and retrospective publications evaluating CI NSAIDs were identified: 12 in abdominal surgery, 7 in orthopedic surgery, and 5 in pediatric surgery. Specific CI NSAIDs utilized included diclofenac, indomethacin, ketoprofen, and ketorolac. Most studies compared the CI NSAID to placebo or an alternative analgesic and evaluated pain control, supplemental opioid use, and related adverse effects. In these surgical populations, CI NSAIDs decreased opioid consumption, alongside provision of adequate pain control. While long-term adverse effects were rarely collected, a decrease in nausea and sedation was often seen with the CI NSAID groups.
Conclusions:
In the abdominal, orthopedic, and pediatric surgical populations, CI NSAIDs represent a feasible alternative modality for perioperative pain control.
OderdaGMSaidQEvansRS. Opioid-related adverse drug events in surgical hospitalizations: impact on costs and length of stay. z. 2007;41:400–407.
3.
MooteC. Efficacy of nonsteroidal anti-inflammatory drugs in the management of postoperative pain. Drugs. 1992;44:14–30.
4.
DahlJBKehletH. Non-steroidal anti-inflammatory drugs: rational for use in severe postoperative pain. Br J Anaesth. 1991;66:703–712.
5.
WuolijokiEOikarinenWJYlpaavalniemiP. Effective postoperative pain control by preoperative injection of diclofenac. Eur J Clin Pharmacol. 1987;32:249–252.
6.
CampbellWKendrickRPattersonC. Intravenous diclofenac sodium. Does its administration before operation suppress postoperative pain?Anaesthesia. 1990;45:753–766.
GilliesGWAKennyGNCBullinghamRES. The morphine sparing effect of ketorolac tromethamine. Anaesthesia. 1987;42:727–731.
9.
BurnsJWAitkenHABullinghamRE. Double blind comparison of the morphine sparing effect of continuous and intermittent IM administration of ketorolac. Br J Anaesth. 1991;67:235–238.
10.
AitkenHABurnsJWMcArdleCS. Effects of ketorolac tromethamol on renal function. Br J Anaes. 1992;68:481–485.
11.
TigerstedtITammistoTNeuvonenPJ. The efficacy of intravenous indomethacin in prevention of postoperative pain. Acta Anaesthesiol Scand. 1991;35:535–540.
12.
PerttunenKKalsoEHeinonenJ. IV diclofenac in post-thoracotomy pain. Br J Anaes. 1992;68:474–480.
13.
RodriguezMJDe La TorreMRPerez-IraolaP. Comparative study of tramadol versus NSAIDs as intravenous continuous infusion for managing postoperative pain. Curr Ther Res. 1993;54(4):375–383.
14.
VarrassiGPanellaLPiroliA. The effects of perioperative ketorolac infusion on postoperative pain and endocrine metabolic response. Anesth Analg. 1994;75:514–519.
15.
BlackburnAStevensJDWheatleyRG. Balanced analgesia with intravenous ketorolac and patient controlled morphine following lower abdominal surgery. J Clin Anesth. 1995;7:103–108.
16.
O’HaraDAFanciulloGHubbardL. Evaluation of the safety and efficacy of ketorolac versus morphine by patient-controlled analgesia for postoperative pain. Pharmacother. 1997;17(5):891–899.
17.
PerttunenKNilssonEKalsoE. IV diclofenac and ketorolac for pain after thoracoscopic surgery. Br J Anaesth. 1999;82:221–227.
18.
RussoADi StasioEBevilacquaF. Efficacy of scheduled time ketorolac administration compared to continuous infusion for postoperative pain after abdominal surgery. Eur Rev Med Pharmacol Sci. 2012;16:1675–1679.
19.
GrimsbyGMConleySPTrentmanTL. A double blind randomized controlled trial of continuous intravenous ketorolac vs placebo for adjuvant pain control after renal surgery. Mayo Clin Proc. 2012;87:1089–1097.
20.
Product information. Ketorolac tromethamine IV, IM injection. Bedford, OH: Bedford Laboratories, 2009.
21.
MattilaMAAhlstrom-BengsEPekkolaP. Intravenous indomethacin or oxycodone in prevention of postoperative pain. Br Med J. 1983;287:1026.
22.
ClaeysMACamuFMaesV. Prophylactic diclofenac infusions in major orthopedic surgery: effects on analgesia and acute phase proteins. Acta Anaesthesiol Scand. 1992;36:270–275.
23.
LaitinenJNuutinenL. Intravenous diclofenac coupled with PCA fentanyl for pain relief after total hip replacement. Anesthesiol. 1992;76:194–198.
24.
HommerilJLBernardJMGouinF. Ketoprofen for pain after hip and knee arthroplasty. Br J Anaesth. 1994;72:383–387.
25.
ReadyLBBrownCRStahlgrenLH. Evaluation of intravenous ketorolac administration by bolus or infusion for treatment of postoperative pain. A double-blind, placebo-controlled, multicenter study. Anesthesiol. 1994;80:1277–86.
26.
EtchesRCWarrinerBBadnerN. Continuous intravenous administration of ketorolac reduces pain and morphine consumption after total hip or knee arthroplasty. Anesth Analg. 1995;81:1175–1180.
27.
KostamovaaraPAHendolinHKokkiH. Ketorolac, diclofenac, and ketoprofen are equally efficacious for pain relief after total hip replacement surgery. Br J Anaesth. 1998;81:369–372.
28.
MaunukselaELOlkkolaKTKorpelaR. Does prophylactic intravenous infusion of indomethacin improve the management of postoperative pain in children?Can J Anaesth. 1988;35(2):123–127.
29.
KokkiHTuovinenKHendolinH. Intravenous ketoprofen and epidural sufentanil analgesia in children after combined spinal-epidural anaesthesia. Acta Anaesthesiol Scand. 1999;43:775–779.
30.
KokkiHTuovinenKHendolinH. The effect of intravenous ketoprofen on postoperative epidural sufentanil analgesia in children. Anesth Analg. 1999;88:1036–1041.
31.
KokkiHSolonenA. Comparison of pre- and postoperative administration of ketoprofen for analgesia after tonsillectomy in children. Paediatr Anaesth. 2002;12:162–167.
32.
JoYYJongYJChoiEK. Ketorolac or fentanyl continuous infusion for postoperative analgesia in children undergoing ureteroneocystostomy. Acta Anaesthesiol Scand. 2011;55:54–59.
33.
RavnskovV. Glomerular, tubular and interstitial nephritis associated with non-steroidal anti-inflammatory drugs. Evidence of a common mechanism. Br J Clin Pharmacol. 1999;47:203–210.
34.
LaitinenJNuutinenLSPuranenJ. Effect of a non-steroidal anti-inflammatory drug, diclofenac, on haemostasis in patients undergoing total hip replacement. Acta Anaesthesiol Scand. 1992;36(5):486–489.
35.
KokkiHKarvinenMJekunenA. Pharmacokinetics of a 24-hour intravenous ketoprofen infusion in children. Acta Anaesthesiol Scand. 2002;46:194–198.
36.
KokkiHKarvinenMSuhonenP. Pharmacokinetics of intravenous and rectal ketoprofen in young children. Clin Pharmacokinet. 2003;42:373–379.
37.
KokkiHTuomilehtoHKarvinenM. Pharmacokinetics of ketoprofen following oral and intramuscular administration in young children. Eur J Clin Pharmacol. 2001;57:643–647.
38.
Trissel’s™ 2 IV Compatibility [Internet database]. Greenwood Village, Colo: Thomson Micromedex. Updated periodically.
39.
HamdiMLentschenerCBazinC. Compatibility and stability of binary mixtures of acetaminophen, nefopam, ketoprofen and ketamine in infusion solutions. Eur J Anaesthesiol. 2009;26:23–27.
