Efﬁcacy of ketorolac in lieu of narcotics in the operative management
of laparoscopic surgery for morbid obesity
Ramasamy Govindarajan, M.D.
*, Biswajit Ghosh, M.D.
Madhan Kumar Sathyamoorthy, M.D.
, Nagendra Srinivas Kodali, M.D.
Ahmed Raza, M.D.
, Judith Aronsohn, M.D.
, Sanjeev Rajpal, M.D., F.A.C.S.
Chitra Ramaswamy, M.B.B.S., M.P.H.
, Adel Abadir, M.D.
Department of Anesthesiology, Brookdale University Hospital and Medical Center, Brooklyn, New York
Department of Bariatric Surgery, Brookdale University Hospital and Medical Center, Brooklyn, New York
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.
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.