Original article
Efficacy of ketorolac in lieu of narcotics in the operative management
of laparoscopic surgery for morbid obesity
Ramasamy Govindarajan, M.D.
a,
*, Biswajit Ghosh, M.D.
a
,
Madhan Kumar Sathyamoorthy, M.D.
a
, Nagendra Srinivas Kodali, M.D.
a
,
Ahmed Raza, M.D.
a
, Judith Aronsohn, M.D.
a
, Sanjeev Rajpal, M.D., F.A.C.S.
b
,
Chitra Ramaswamy, M.B.B.S., M.P.H.
c
, Adel Abadir, M.D.
a
a
Department of Anesthesiology, Brookdale University Hospital and Medical Center, Brooklyn, New York
b
Department of Bariatric Surgery, Brookdale University Hospital and Medical Center, Brooklyn, New York
c
Statistical Consultant, Department of Anesthesiology, Brookdale University Hospital and Medical Center, Brooklyn, New York
Manuscript received May 13, 2005; revised August 27, 2005; accepted August 30, 2005
Background: Prompt recovery of protective airway reflexes, freedom from pain, ability to coop-
erate with respiratory physical therapy, early ambulation and discharge from the postanesthesia care
unit (PACU), coupled with a stable intraoperative environment have been desired goals of anes-
thesia management of morbidly obese patients. We used ketorolac in lieu of narcotics toward this
goal and present our subjective and objective data in this study.
Methods: A total of 50 morbidly obese patients undergoing laparoscopic gastric bypass surgery
were randomly assigned to 2 groups of 25 each. Group I received intravenous ketorolac periopera-
tively, which was continued 24 hours postoperatively. Group II received remifentanyl intraopera-
tively as a part of balanced anesthesia. Intraoperative hemodynamic stability was assessed based on
blood pressure, pulse rate, and bispectral index score values. Postoperative pain intensity using a
visual analogue scale, as well as the presence of nausea, vomiting, hypotension, or respiratory
depression, were also recorded.
Results: Postoperative side effects, including pain, nausea, and vomiting; requirements for analgesics
and antiemetic medications in the PACU; and the time spent in the PACU varied significantly between
the 2 groups. Continued administration of ketorolac during the first 24 hours postoperatively led to
improved patient satisfaction and more enthusiastic participation in respiratory physical therapy.
Conclusions: Perioperative use of intravenous ketorolac up to 24 hours after laparoscopic gastric
bypass surgery for morbid obesity helps provide a more stable intraoperative environment, earlier
discharge from the PACU, and better outcome in this subset of patients. © 2005 American Society
for Bariatric Surgery. All rights reserved.
Keywords: Morbid obesity; Laparoscopic surgery; Ketorolac; Postoperative nausea and vomiting; Duration of PACU stay;
Respiratory physical therapy; Patient satisfaction
Prompt recovery of protective airway reflexes, free-
dom from pain, ability to cooperate with respiratory
physical therapy, early ambulation and discharge from
the postanesthesia care unit (PACU), coupled with a
stable intraoperative environment, have been desired
goals of anesthetic management of morbidly obese pa-
tients. The present study was designed to evaluate the
analgesic efficacy, intraoperative stability, postanesthesia
recovery, duration of PACU stay, postoperative compli-
cations and patient satisfaction in a randomized trial of
ketorolac in lieu of narcotics in the operative manage-
ment of laparoscopic surgery for morbid obesity.
*Reprint requests: R. Govindarajan, MD, 86-75 Midland Parkway,
#4R, Jamaica, NY 11432.
e-mail: ramasgovi@hotmail.com
Surgery for Obesity and Related Diseases 1 (2005) 530 –536
1550-7289/05/$ – see front matter © 2005 American Society for Bariatric Surgery. All rights reserved.
doi:10.1016/j.soard.2005.08.013