Early reports suggested that parenteral NSAIDs possessed analgesic
properties comparable to those for traditional opioid analgesics108–110 without opioid-related side effects.111,112
Compared with the partial opioid agonist tramadol, diclofenac produced
better postoperative pain relief with fewer side effects after cardiac
surgery.8 When administered as an adjuvant during
outpatient anesthesia, ketorolac was associated with improved postoperative
analgesia and patient comfort compared with fentanyl and the partial opioid
agonist, dezocine.112,113 Other investigators reported
that ketorolac provided postoperative pain relief similar to that of
fentanyl, but was associated with less nausea and somnolence, as well as an
earlier return of bowel function.114 In most studies, use
of ketorolac has been associated with a less frequent incidence of PONV than
the opioid analgesics. As a result, patients tolerate oral fluids and are
fit for discharge earlier than those receiving only opioid analgesics during
the perioperative period. Of interest, ketorolac (30 mg q6h) was superior to
a dilute local anesthetic infusion (bupivacaine 0.125%) in supplementing
epidural IVPCA hydromorphone in patients undergoing thoracotomy
procedures.115 Furthermore, it has been found that the
injection of ketorolac (30 mg) at the incision site in combination with
local anesthesia resulted in significantly less postoperative pain, a better
quality of recovery, and earlier discharge compared with local anesthesia
alone.116 In fact, evidence exists for both a peripheral
and central analgesic action of NSAIDs.117 However, when
ketorolac was substituted for, or combined with, fentanyl during minor
gynecologic and laparoscopic procedures, beneficial effects of the NSAID
were reduced.118,119