KETOROLAC

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Ketorolac is an important adjunct in the field of anesthesia and perioperative pain management due to its potent analgesic properties and its ability to reduce the reliance on opioid medications. Its importance in anesthesia can be highlighted by the following factors:

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1. Multimodal analgesia: Ketorolac is an integral component of multimodal analgesia, which is the practice of using multiple analgesic medications with different mechanisms of action to achieve better pain control while minimizing the side effects associated with any single medication. This approach can improve patient comfort, reduce the risk of side effects, and shorten recovery time.

2. Opioid-sparing effect: Ketorolac, as a potent non-opioid analgesic, can reduce the need for opioid medications in the perioperative period. This opioid-sparing effect is particularly important given the potential side effects of opioids, such as respiratory depression, nausea, vomiting, constipation, and the risk of dependence.

3. Anti-inflammatory properties: As a nonsteroidal anti-inflammatory drug (NSAID), ketorolac has inherent anti-inflammatory properties that can help reduce local inflammation and swelling after surgery, contributing to better pain control and faster recovery.

4. Reduction of postoperative pain: Ketorolac has been shown to be effective in reducing postoperative pain when administered either preoperatively, intraoperatively, or postoperatively. Adequate pain control can lead to improved patient satisfaction, faster mobilization, and a shorter hospital stay.

5. Potential synergistic effects: When combined with other analgesic medications, such as opioids, acetaminophen, or regional anesthesia techniques, ketorolac may have a synergistic effect, resulting in enhanced pain relief.

 

Here are the main steps in ketorolac's mechanism of action:

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1. Inhibition of COX enzymes: Ketorolac non-selectively inhibits both isoforms of the COX enzyme, COX-1 and COX-2. These enzymes are involved in the conversion of arachidonic acid to prostaglandins, which are lipid compounds that play a crucial role in the inflammatory response and the modulation of pain perception.

2. Suppression of prostaglandin synthesis: By inhibiting the COX enzymes, ketorolac reduces the synthesis of prostaglandins, particularly prostaglandin E2 (PGE2), which is known to increase pain sensitivity by sensitizing nerve endings to pain stimuli.

3. Reduction of inflammation and pain: The overall effect of ketorolac's action on the COX enzymes is a decrease in inflammation and pain perception. This leads to relief from moderate to severe pain, particularly in the postoperative setting or for other acute pain conditions.

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                                                                                         Key points about Ketorolac

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• Parenteral nonsteroidal anti-inflammatory drug (NSAID).

 

• Exhibits analgesic, anti-inflammatory, and antipyretic activity by inhibiting prostaglandin synthesis.

 

• Inhibits platelet aggregation and prolongs bleeding time.

 

• Long-term administration may lead to renal toxicity or GI tract ulceration with bleeding.

 

• Elderly patients clear Ketorolac slower and should receive reduced doses.

 

• It is best avoided in patients with a history of peptic ulcer disease and renal impairment.

 

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