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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.23217    [Epub ahead of print]
Published online June 14, 2023.
Reduced side effects and improved pain management by continuous ketorolac infusion with patient-controlled fentanyl injection compared with single fentanyl administration in pelviscopic gynecologic surgery: a randomized, double-blind, controlled study
Insun Park, Seukyoung Hong, Su Yeon Kim, Jung-Won Hwang, Sang-Hwan Do, Hyo-Seok Na
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
Corresponding author:  Hyo-Seok Na, Tel: +82 31 787 7507, Fax: +82 31 787 4063, 
Email: hsknana@gmail.com
Received: 9 March 2023   • Revised: 12 June 2023   • Accepted: 13 June 2023
A combination of opioids with adjunctive drugs can be used for intravenous patient-controlled analgesia (PCA) to minimize opioid-related side effects. Herein, we investigated whether two different analgesics administered separately via a dual-chamber PCA may have fewer side effects with adequate analgesia than single fentanyl PCA in gynecologic patients undergoing pelviscopic surgery.
This prospective, double-blinded, randomized and controlled study included 68 patients who underwent pelviscopic gynecological surgery. Patients were randomly allocated to either the dual (ketorolac and fentanyl delivered by a dual-chamber PCA) or the single (fentanyl alone) group. PONV and analgesic quality were compared between the two groups at 2, 6, 12, and 24 h postoperatively.
The dual group showed a significantly lower incidence of PONV during postoperative 2–6 h (P = 0.011) and 6–12 h (P = 0.009). Finally, only 2 patients (5.7%) in the dual group and 18 (54.5%) in the single group did experience PONV during the entire postoperative 24 h, who could not maintain intravenous PCA (OR, 0.056; 95% CI, 0.007-0.229; P < 0.001). Despite less fentanyl was administered via intravenous PCA during the postoperative 24 h in the dual group than in the single group (66.0 ± 77.8 μg vs. 383.6 ± 70.1 μg, P < 0.001), postoperative NRS for pain had no significant intergroup difference.
Two different analgesics, continuous ketorolac and intermittent fentanyl bolus, administered via dual-chamber intravenous PCA, showed fewer side effects with adequate analgesia than conventional intravenous fentanyl PCA in gynecologic patients undergoing pelviscopic surgery.
Key Words: Analgesia; Fentanyl; Ketorolac; Patient-controlled analgesia; Postoperative nausea and vomiting; Postoperative pain
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