Twenty-four-hour postoperative orphenadrine and ketorolac infusion efficiently precedes orphenadrine-diclofenac infusion as an opioid-sparing analgesic modality after mastectomy

Dabour, Yehya Shahin; Elnoury, Ahmed Said; Daoud, Ahmed Abouelgheit

doi:TEJA-2023-0102

Twenty-four-hour postoperative orphenadrine and ketorolac infusion efficiently precedes orphenadrine-diclofenac infusion as an opioid-sparing analgesic modality after mastectomy

Authors

TEJA-2023-0102

Abstract

Objectives
Determination of the efficacy of postoperative (PO) infusion of orphenadrine/ketorolac (O/KT) combination for 24-h as PO analgesia and its opioid-sparing rate (OSR) compared to orphenadrine/diclofenac (O/D) and Placebo infusions for women undergoing Modified Radical Mastectomy.
Patients & Methods
A total of 129 women with operable cancer breast received the same anesthetic procedure and were randomly divided into groups I–III according to the PO infusion. Infusions were started before skin closure for 60-min and were repeated for 8-hourly for 24-h. Pain severity was assessed using the numeric rating scale (NRS) and at NRS scores >4, morphine 5 mg was given. The OSR was defined as the number of patients who required no PO morphine in the study outcome.
Results
The OSR was significantly higher with O/KT than with O/D infusion (72.1% vs. 51.2%, respectively) and the frequency of requesting multiple doses of morphine was significantly lower with O/KT than other infusions with significant difference in favor of O/D infusion than placebo. The frequency of early requests of morphine was significantly lower with O/KT having a significantly longer duration till the first request. The average pain scores were significantly lower with O/KT infusion. PO morphine-related side effects were significantly higher, while patient and surgeon’s satisfaction scores were significantly lower among patients of the placebo group.
Conclusion
Cocktails of ketorolac or diclofenac with orphenadrine infusions for 24-h after mastectomy improve PO pain sensation with a reduction of opioid consumption. The O/KT infusion was superior to the O/D infusion with regard to OSR and pain scores.

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