Clinical trial NCT01230463: Study of Whether 15 mg Dose of Ketorolac IV is as Effective as a 30 mg Dose.
Official title: Intraoperative Ketorolac Dose of 15 mg Versus the Standard 30 mg on Early Postoperative Pain After Spine Surgery: A Randomised, Blinded, Non-Inferiority Trial
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Pain
Pain, Postoperative
Keywords: Pain, Postoperative
Ketorolac
Anti-Inflammatory Agents, Non-Steroidal
Intraoperative Care
Lead sponsor: University of Calgary
Sponsor class: OTHER
First posted: 2010-10-29
Enrollment: 50
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The primary aim of this study is to show the non-inferiority of 15 mg intraoperative dose of ketorolac as compared to the standard 30 mg ketorolac by looking at the VAS scores 4 hours after an adult spine surgery.

Detailed description: Opioids have traditionally been the cornerstone of acute postoperative pain management. Problematic side effects such as nausea, vomiting, ileus, urinary retention, excess sedation, and respiratory depression are significant disadvantages with the use of opioids. Alternative treatments have been sought. The concept of adding a nonsedating non opioid analgesic agent is appealing and has been validated by previous studies. Nonsteroidal anti-inflammatory drugs (NSAID) are nonsedating and combine analgesic and anti-inflammatory properties ideal for pain after surgery.

Ketorolac is a potent intravenous nonsteroidal anti-inflammatory drug (NSAID), and a non selective cyclooxygenase inhibitor which mediates pain, inflammation and fever. It has been evaluated and used for treatment of moderate to severe pain including postoperative pain. Although intravenous route is not approved by Health Canada, its use is supported in medical literature and clinical practice.

Previous studies have demonstrated the effectiveness of standard 30 mg intravenous ketorolac as an adjunct to opioids for postoperative pain relief. Standard parenteral dose recommended by manufacturer for healthy non elderly population is 30 mg based on a number clinical trials.

Alberta Health Services (AHS) Pharmacy formulary has approved the intravenous use of ketorolac in the dosage range of 10-30 mg depending the patient's weight and medical comorbidities.

NSAIDs, including ketorolac, have an analgesic ceiling effect in which higher doses do not provide any additional pain relief but may increase the likelihood of side effects. Single dose IM ketorolac have been studied in the past showing no difference in analgesia with the 30 and 90 mg dose. Because of risk of drug toxicity and unwanted side effects, patients should be given the lowest effective ketorolac dose. Low dose ketorolac was studied in the adolescents undergoing spine surgery and showed that dose of 0.2mg/kg (11mg) provides supplemental analgesia postoperatively. However, there were no previous studies found on review of the literature using medline search that look at parallel comparison between intraoperative doses of ketorolac in terms of efficacy and safety profile.

Eligibility criteria: Inclusion Criteria:

* Patients booked for 1-2 level spine laminectomies and/or decompression
* Adult 18 - 65 years
* Weight of 50 - 110 kg

Exclusion Criteria:

* Previous lumbar laminectomy
* Current anticoagulant use with INR \> 1.2
* Narcotic use \> 4 weeks
* Known allergy or sensitivity to NSAID or morphine
* Renal insufficiency with creatinine \>100 umol/L
* Known liver disease
* History of gastrointestinal bleeding
* Pregnancy, history of bronchial asthma
* NSAID use 2 days before surgery.

Primary outcomes:
measure: Visual Analog Score
timeFrame: Four hours after surgery
Secondary outcomes:
measure: Morphine Usage After Surgery
timeFrame: 8 hours and 24 hours after surgery
measure: Morphine Adverse Effects
timeFrame: First 24 hours
measure: Postoperative Bleeding
timeFrame: 24 hours after surgery
Other outcomes:
Locations:
city: Calgary
country: Canada
facility: Foothills Medical Centre
state: Alberta
Study officials:
affiliation: University of Calgary - Department of Anesthesia
name: Kaylene Duttchen, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: University of Calgary - Department of Anesthesia
name: Melinda Davis, MD
role: PRINCIPAL_INVESTIGATOR
References: