ON-Q Pump Infusion of Ketorolac and Ropivacaine at the Wound Site for Postoperative Pain Management
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional
Phase: Phase 4

Summary: 
      After surgery it is normal to experience some pain at the site of operation. In order to
      reduce the pain, medication such as Morphine is injected into a vein using a Patient
      Controlled Analgesia (PCA) pump that is kept at bed side, and is activated by the patient
      when needed. However, Morphine is an opioid drug, which can cause side effects such as
      sedation, nausea, vomiting, and reduced breathing on prolonged use. In addition to the opioid
      drugs, local anesthetics, and other drugs called Non steroidal anti inflammatory drugs
      (NSAIDs) have been injected locally to provide prolonged pain relief without the side effects
      of morphine. Recently a portable device called ON-Q pump has been developed to continuously
      infuse the local anesthetic through 2 small catheters inserted at the wound site. The ON-Q
      Pump is a small tennis ball sized unit made of a soft synthetic material that slowly infuses
      the drug through the catheters by elastic force. This pump is very safe and is attached to a
      bedside pole or the patient's hospital gown. This pump has already been approved by the FDA
      for clinical use, and has been reported to provide effective pain management after some
      surgical procedures.

      The primary aim of the present study is to evaluate the relative efficacy of the drugs
      Ketorolac and Ropivacaine infused through the ON-Q pump in reducing the pain following
      gynecologic surgery. Ketorolac and Ropivacaine are approved drugs that are frequently used
      for post operative pain relief. Our hypothesis is that these two drugs in combination will
      provide better analgesia than Ketorolac alone.
    

Detailed description: 
      This study would include a total of 60 patients randomized into 2 equal groups. Patients will
      be interviewed in the holding area and informed signed consent will be obtained. Patients
      will be induced with general anesthesia in keeping with standard practice. At the end of
      surgical procedure, before the patient is extubated, the Surgeon will secure the 2 catheters
      of the ON-Q pump at two levels of the fascia near the incision site. First the surgeon will
      instill at the wound site a bolus dose of 30 ml of 0.9% saline with 10 mg Ketorolac in Group
      I, or 30 ml of saline with 0.5% Ropivacaine and 10 mg Ketorolac in Group II patients. Then
      the continuous infusion with the ON-Q pump will be started at 4 ml/hr, and Group I patients
      will receive saline with Ketorolac at 5 mg/hr not to exceed 120 mg per day, and Group II will
      receive saline with 0.5% Ropivacaine plus Ketorolac at 5 mg/hr. Patients will be extubated,
      as per standard anesthetic practice. All patients will receive anti ulcer medication. On
      arrival at the Post Anesthesia Care Unit (PACU), the patient will receive an i.v. PCA pump,
      which will administer Morphine Sulfate 2 mg in incremental doses on demand by the patient.

      A blinded investigator will collect the study data from each patient at 6, 12, 24, and 48 hrs
      postoperative periods. The data collected would include 1) Visual Analog Scale (VAS) scores
      for pain at rest, on coughing and on moving, 2) PCA demands by the patient and actual
      deliveries of morphine, 3) "rescue" analgesic requirements (for pain score of 4 or greater).
      4) VAS scores for Nausea, drowsiness, and satisfaction, and 5) number of vomiting.
    

Intervention name(s): Ketorolac; Ketorolac and Ropivacaine
Intervention type(s): Drug; Drug
Intervention description(s): Patients will receive Ketorolac at 5 mg/hr not to exceed 120 mg/day; Patients will receive Ketorolac at 5 mg/hr plus 0.5% Ropivacaine
Other intervention name(s): Toradol; Toradol and Naropin
Intervention MeSH terms: Ketorolac; Ketorolac Tromethamine; Ropivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment