Ketorolac for Postoperative Analgesia Following Mastectomy

  • Suppression of prostaglandin synthesis at sites of inflammation:
    • Is the primary mechanism behind the antinociceptive effects of nonsteroidal anti-inflammatory drugs (NSAIDs)
  • NSAIDs inhibit the activity of the cyclooxygenase isoforms 1 and 2, and their use can decrease opioid consumption
  • Opioids prescribed preoperatively can lead to long-term use
  • Risk factors for chronic opioid use after surgery among opioid-naive patients include:
    • Male gender
    • Age greater than 50 years
    • Preoperative use of benzodiazepines
    • Preoperative use of antidepressants
    • Depression history
    • Alcohol abuse history
    • Drug abuse history
  • A systematic review of the literature demonstrated that:
    • Co-administration of acetaminophen and NSAIDs:
      • Decreased 24-hour postoperative morphine consumption
  • Multimodal regimens are thought to have synergistic and opioid-sparing effects
  • Intravenous lidocaine is one such opioid-sparing agent:
    • It exerts its analgesic effect by blocking sodium channels responsible for neural transmission of pain impulses
  • N-methyl-D-aspartate receptor antagonism:
    • Describes the mechanism of ketamine, an opioid-sparing agent
  • Regional nerve blockade and neuraxial anesthesia is theorized to prevent persistent opioid use by preventative analgesia:
    • Directly blocking pain impulses preventing central sensitization
  • Inhibition at glutamatergic synapses:
    • Describes the antinociceptive mechanism of action of magnesium
  • References:
    • Brown, EN, Pavone KJ, Naranjo M. Multimodal general anesthesia: theory and practice. Anesth Analg. 2018;127(5):1246–1258.
    • Hah, JM, Bateman BT, Ratliff J, Curtin C, Sun E. Chronic opioid use after surgery: implications for perioperative management in the face of the opioid epidemic. Anesth Anal. 2017;125(5):1733–1740.
    • Dunn LK, Durieux ME. Perioperative use of intravenous lidocaine. Anesthesiology. 2017;126:729–737

#Arrangoiz #BreastSurgeon #CancerSurgeon #SurgicalOncologist #BreastCancer #PostoperativePain #Ketorolac #NSAID #Miami #Teacher #Surgeon #MountSinaiMedicalCenter

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s