Korean J Ophthalmol.  2013 Aug;27(4):229-234. 10.3341/kjo.2013.27.4.229.

Comparison of Pain-relieving Effects of Fentanyl versus Ketorolac after Eye Amputation Surgery

• Kim JH
• Jang SY
• Kim MJ
• Lee SY
• Yoon JS

• KMID: 1705417
• DOI: http://doi.org/10.3341/kjo.2013.27.4.229

Abstract

PURPOSE
To investigate the analgesic effect and incidence of postoperative nausea and vomiting (PONV) between the opioid fentanyl and the non-steroidal anti-inflammatory drug ketorolac in patients who underwent eye amputation surgery.
METHODS
Retrospective observational case series. Eighty-two patients underwent evisceration or enucleation surgery by one surgeon over a 2-year period. Fentanyl by intravenous patient-controlled analgesia (IV-PCA) at 20 microg/kg with 12 mg/kg ondansetron or intravenous ketorolac at 2 mg/kg/day was administered to patients at postoperative days 0, 1, and 2. The pain score was measured using an 11-point visual analog scale (VAS). The incidence of severe nausea requiring anti-emetics and the incidence of vomiting were reviewed.
RESULTS
The mean postoperative VAS in the fentanyl group was significantly lower than that in the ketorolac group on the day of operation for both types of surgery (p = 0.001 and p = 0.004, respectively). At postoperative days 1 and 2, the mean VAS was not different between the two groups for either surgical type (p > 0.05 for both days). The mean VAS was significantly higher in eviscerated patients than in enucleated patients at postoperative days 0 and 1 in the fentanyl group (p = 0.023 and p = 0.016, respectively). However, this was not observed in the ketorolac group. The incidence of PONV was higher in the fentanyl group than in the ketorolac group, although this was not statistically significant for either surgical type (p > 0.05 for both groups).
CONCLUSIONS
Fentanyl was more effective as an analgesic than was ketorolac on the day of operation for both surgical types. There was no difference between the two analgesics on postoperative day 1. The analgesic effect of fentanyl in enucleated patients was significantly higher than in eviscerated patients at postoperative days 0 and 1. The use of fentanyl by IV-PCA was associated with greater PONV despite co-administration with anti-emetics, although this finding was not significant.

Keyword

Analgesic effect; Eye amputation; Fentanyl; Ketorolac; Postoperative nausea and vomiting

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Analgesics, Opioid/therapeutic use
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
*Eye Enucleation
*Eye Evisceration
Female
Fentanyl/*therapeutic use
Humans
Ketorolac/*therapeutic use
Male
Middle Aged
Pain, Postoperative/*drug therapy
Retrospective Studies
Treatment Outcome
Young Adult
Analgesics, Opioid
Anti-Inflammatory Agents, Non-Steroidal
Fentanyl
Ketorolac

Figure

• 

  Fig. 1 (A) Total postoperative pain analogue scores recorded by patients who received analgesics after evisceration or enucleation surgery. (B) Postoperative pain analogue scores compared by analgesic after eye amputation surgery. Circles (fentanyl group) and triangles (ketorolac group). (C) Postoperative pain analogue scores compared by surgical type. Circles (evisceration group) and triangles (enucleation group). POD = postoperative day.

• 

  Fig. 2 Incidence of postoperative nausea and vomiting symptoms during the study period. IV-PCA = intravenous patient-controlled analgesia.

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