For a study, researchers sought to evaluate the effects of intraoperative IV ketorolac (Toradol) on the post-operative total morphine milligram equivalent (MME) needs of patients having ureteroscopy for nephrolithiasis.

Ketorolac was administered in a randomized fashion to patients who were having an ambulatory ureteroscopy for nephrolithiasis. Both patients and surgeons blinded treatment. Calculations were made for intraoperative, postoperative, and combined MME. Regression with many variables was used to find independent predictors of MME need. There were complications noted.

After randomization, 94 patients in total were analyzed. About 48 patients were in the control arm, and 46 patients were in the treatment arm. Between groups, there were no statistically significant differences in terms of gender, age, BMI, operating time, or initial usage of painkillers (P>.05). When compared to the control arm, patients in the treatment arm needed less intraoperative MME (17.1 vs. 24, P<.01). The postoperative MME needs did not differ statistically significantly across groups. When compared to the control arm, the cumulative peri-operative MME was lower in the treatment arm (22.2 vs. 30.4, P<.02). On multivariable analysis, ketorolac consumption was an independent predictor of reduced MME use (beta coefficient -5.1, P<.01). Regarding the number of complications, there was no statistically significant difference between the treatment groups.

Ketorolac use during ureteroscopy is linked to a 37% decrease in the demand for narcotics and is a reliable indicator of lower peri-operative narcotic need. The results demonstrated that, unless otherwise contraindicated, intra-operative ketorolac usage successfully lowers the need for narcotics and should be taken into consideration either independently or as part of a multimodal pain management regimen.