Presentation Authors: Jamil Syed, Matthew Goland-Van Ryn*, Jonathan Huang, Piruz Motamedinia, New Haven, CT
Introduction: We evaluated the impact of up-front ketorolac (Toradol) on the peri-operative total morphine equivalent (ME) requirements of patients undergoing ureteroscopy for nephrolithiasis.
Methods: Patients undergoing ambulatory ureteroscopy were prospectively randomized to receive ketorolac at induction vs. anesthesia per-usual intraoperatively. Patients and surgeons were blinded to treatment. Exclusion criteria included NSAID related asthma or allergy, renal insufficiency, peptic ulcer disease, bleeding diathesis, pregnancy/breast feeding, and advanced age. Intraoperative, postoperative and combined ME were calculated. Multivariable regression was used to identify independent predictors of ME requirement. A p-value of less than 0.05 was used to indicate statistical significance.
Results: A total of 51 people were randomized. There were no differences in gender, age, BMI, or baseline pain medication use between groups. There were no differences in mean intraoperative or combined peri-operative ME for patients who received ketorolac. The treatment group had less ME use in the post-operative period, (4.8mg vs 9.2mg, p= 0.028). (Table 1) On multivariable analysis, increased age, intraoperative ketorolac, and unilateral surgery were all independent predictors of less morphine equivalent use. (Table 2) There were no ketorolac related complications.
Conclusions: Administering ketorolac at the time of ureteroscopy is associated with a 50% reduction of narcotic requirement for patients in the recovery room and is an independent predictor of overall decreased peri-operative narcotic needs. These findings suggest that routine intra-operative use of ketorolac should be considered in all patients, unless otherwise contraindicated.