AUA 2019: The Impact of Intraoperative Ketorolac on Overall Narcotic Requirements in Patients Undergoing Ureteroscopy

Chicago, IL (Urotoday.com) In this study, Dr. Matthew Goland-Van Ryn analyzed the impact of ketorolac (Toradol) medications on the intraoperative, postoperative and combined total morphine milligram equivalents (ME) required for patient satisfaction for those patients undergoing standard ureteroscopy for nephrolithiasis.

Fifty-one patients diagnosed with nephrolithiasis requiring ambulatory surgical intervention were included in this study. There were no significant differences in measures such as age, sex, BMI nor baseline pain medication usage. Patients were prospectively randomized to either standard anesthesia methodologies or to receive 30mg of ketorolac at the time of induction; both patients and surgeons were blinded to the treatment arms. Patients with an allergy to the medication or nonsteroidal anti-inflammatory drugs (NSAIDs) were excluded from participation. Postoperative, intraoperative and combined ME requirements were calculated and multivariable regression was used to identify potential independent predictors of ME requirements.

This study concluded that the administration of a ketorolac drug during the time of standard ureteroscopy was advantageous to patient recovery; providing a 50% decrease in the amount ME needed to achieve patient satisfaction and effective pain management. Dr. Goland-Van Ryn suggested the use of this technique for all patients, excluding those with extensive comorbidities or other complexities.

Upon a moderator prompted question regarding dosages, Dr. Goland-Van Ryn commented on the lack of current standardization in the dosage of ketorolac medications that are provided at induction. He emphasized that there is a wide range of dosages given solely based on the discretion of the providing anesthesiologist, rather from scientifically established guidelines.

Presented by: Matthew Goland-Van Ryn, MD, Yale New Haven Hospital

Co-authors: Jamil Syed MD, Matthew Goland-Van Ryn MD, Jonathan Huang MD, and Piruz Motomedinia MD
Affiliation: Yale School of Medicine, Department of Urology, New Haven, CT

Written by: Courtney Cottone, (Department of Urology, University of California-Irvine) at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois
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