Drugs

, Volume 44, Supplement 5, pp 14–30

Efficacy of Nonsteroidal Anti-Inflammatory Drugs in the Management of Postoperative Pain

  • Carol Moote
Article

Summary

Nonsteroidal anti-inflammatory drugs (NSAIDs) are very effective for the management of acute postoperative pain. These agents can be used in combination with opioid analgesics and local anaesthetics for the relief of severe postoperative pain, when the combination results in reduced narcotic requirements and improved analgesia compared with opioids and/or local anaesthetics. NSAIDs have been shown to be effective in a wide variety of postoperative pain states, including thoracotomy, major orthopaedic surgery such as hip arthroplasty, upper and lower abdominal surgery and minor outpatient surgery. The benefits of combining NSAIDs with opioid analgesics in the immediate postoperative period include not only improved analgesia but also the benefits associated with narcotic sparing (improved respiratory function, reduction in nausea and vomiting, reduced sedation) and there is a suggestion that NSAIDs may improve not only the quality but also the speed of recovery. By adding the NSAIDs to a routine analgesic armamentarium the goal of preventing or eliminating postoperative pain, rather than treating or reducing postoperative pain, is achieved. To use these agents more effectively, further research is required to distinguish the differences between the various NSAIDs, the optimal dosage schedules and route of administration, and, finally, the cost-effectiveness and impact on the quality and speed of postoperative recovery of NSAIDs.

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References

  1. Aho MS, Erkola OA, Scheinin H, Lehtinen AM, Korttila K. Effect of intravenously administered dexmedetomidine on pain after laparoscopic tubal ligation. Anesthesia and Analgesia 73: 112–118, 1991PubMedGoogle Scholar
  2. Anderson SK, Al-Shaikh BA. Diclofenac in combination with opiate infusion after joint replacement surgery. Anaesthesia and Intensive Care 19: 535–8, 1991PubMedGoogle Scholar
  3. Angell M. The quality of mercy. New England Journal of Medicine 306: 98–99, 1982PubMedGoogle Scholar
  4. Anonymous. Postoperative pain relief and non-opioid analgesics. Lancet 337: 524–526, 1991Google Scholar
  5. Badner NH, Reimer El, Komar WE, Moote CA. Low-dose bu-pivacaine does not improve postoperative epidural fentanyl analgesia in orthopedic patients. Anesthesia and Analgesia 72: 337–341, 1991PubMedGoogle Scholar
  6. Bellamy CD, Chovan J, Brose EL, Gunzenhauser L. Ketorolac superior to sufentanil, giving longer pain relief with less nausea and less recovery time after laparoscopy. Anesthesiology 75: A29, 1991Google Scholar
  7. Bhounsule SA, Nevreker PR, Agshikar NV, Pal MN, Dhume VG. A comparison of four analgesics in post-episiotomy pain. Indian Journal of Physiology and Pharmacology 34: 34–8, 1990PubMedGoogle Scholar
  8. Bloomfield SS, Barden TP, Mitchell J. Comparative efficacy of ibuprofen and aspirin in episiotomy pain. Clinical Pharmacology and Therapeutics 15: 565–570, 1974PubMedGoogle Scholar
  9. Bosek V. Ketorolac versus fentanyl analgesia for outpatients undergoing operations with local anesthesia. Anesthesiology 75: A762, 1991Google Scholar
  10. Brandon Bravo LJC, Mattie H, Spierdijk J, Bovill JG, Burm AGL. The effects on ventilation of ketorolac in comparison with morphine. European Journal of Clinical Pharmacology 35: 491–494, 1988Google Scholar
  11. Breivik H, Stenseth R, Apalseth K, Spilsberg AM. Piroxicam, ace-tylsalicylic acid and placebo for postoperative pain. Acta An-aesthesiologica Scandinavica. 28: 37–39, 1984Google Scholar
  12. Bridenbaugh PO. Post-op pain relief: does the technique matter? Refresher course. International Anesthesia Research Society Supplement to Anesthesia & Analgesia: 35-38, 1992Google Scholar
  13. Brodie BL, Casper RF. Prostaglandins mediate postoperative pain in Falope ring sterilization. American Journal of Obstetrics and Gynecology 151: 175–177, 1985PubMedGoogle Scholar
  14. Buchanan JM, Balbasera J, Halshaw J, Dallard JK, Poole PH. Postoperative pain relief; a new approach: narcotics compared with non-steroidal antiinflammatory drugs. Annals of the Royal College of Surgeons of England 70: 332–335, 1988PubMedGoogle Scholar
  15. Burns JW, Aitken RES, Bullingham CS, McArdle CS, Kenny GNC. Double-blind comparison of the morphine sparing effect of continuous and intermittent I.M. administration of ketorolac. British Journal of Anaesthesia 67: 235–238, 1991PubMedGoogle Scholar
  16. Cailleteau JG. Ketoprofen in dentistry: a pharmacologic review. Oral Surgery Oral Medicine and Oral Pathology 66: 620–624, 1988Google Scholar
  17. Campbell WI. Analgesic side effects and minor surgery: which analgesic for minor and daycase surgery? British Journal of Anaesthesia 64: 617–620, 1990PubMedGoogle Scholar
  18. Campbell WI, Kendrick R, Patterson C. Intravenous diclofenac sodium. Does its administration before operation suppress postoperative pain? Anaesthesia 45: 763–766, 1990PubMedGoogle Scholar
  19. Carlborg L, Lindoff C, Hellman A. Diclofenac versus pethidine in the treatment of pain after hysterectomy. European Journal of Anaesthesiology 4: 241–247, 1987PubMedGoogle Scholar
  20. Cashman JN, Jones RM, Foster JM, Adams AP. Comparison of infusions of morphine and lysine acetyl salicylate for the relief of pain after surgery. British Journal of Anaesthesia 57: 255–258, 1985PubMedGoogle Scholar
  21. Cattaneo AD, Roccatagliata D. The analgesic effect of intravenous indoprofen and lysine acetylsalicylate in patients with postoperative pain. Journal of Clinical Pharmacology 20: 475–479, 1980PubMedGoogle Scholar
  22. Chan VWS, Chung F, Mati N, Evans D, Cruise C, et al. Patient controlled analgesia (PCA); used patterns in abdominal and thoracic surgery. Canadian Journal of Anaesthesia A115, 1991Google Scholar
  23. Cohen FL. Postsurgical pain relief: patients’ status and nurses’ medication choices. Pain 9: 265–274, 1980PubMedGoogle Scholar
  24. Colquhoun AD, Fell D. Failure of rectal diclofenac to augment opioid analgesia after cholecystectomy. Anaesthesia 44: 57–60, 1989PubMedGoogle Scholar
  25. Comfort VK, Code WE, Rooney ME. Naproxen premedication for the reduction of postoperative tubal ligation pain. Canadian Journal of Anaesthesia 38: A37, 1991Google Scholar
  26. Cooper SA. Ketoprofen in oral surgery pain: a review. Journal of Clinical Pharmacology 28: 540, 1988Google Scholar
  27. Crossley HL, Bergman SA, Wynn RL. Nonsteroidal anti-inflammatory agents in relieving dental pain: a review. Journal of the American Dental Association 106: 61–64, 1983PubMedGoogle Scholar
  28. Dahl JB, Kehlet H. Non-steroidal anti-inflammatory drugs: rationale for use in severe postoperative pain. British Journal of Anaesthesia 66: 703–712, 1991PubMedGoogle Scholar
  29. De Conno F, Ripamonti C, Gamba A, Prada A, Ventafridda V. Treatment of postoperative pain: comparison between administration at fixed hours and ‘Ison demand’ with intramuscular analgesics. European Journal of Surgical Oncology 15: 242–246, 1989PubMedGoogle Scholar
  30. DeLucia JA, White DO, White PF. Effect of intraoperative ketorolac on recovery profile after outpatient laparoscopy. Anesthesiology 75 (Suppl.): A14, 1991Google Scholar
  31. Dodson ME. A review of methods for relief of postoperative pain. Annals of the Royal College of Surgeons of England 64: 324–327, 1982PubMedGoogle Scholar
  32. Donovan BD. Patient attitudes to postoperative pain relief. Anaesthesia and Intensive Care 11: 125–129, 1983PubMedGoogle Scholar
  33. Dupuis R, Lemay H, Bushnell MC, Duncan GH. Preoperative flurbiprofen in oral surgery: a method of choice in controlling postoperative pain. Pharmacotherapy 8: 193–200, 1988PubMedGoogle Scholar
  34. Durante E, Dal PM, Pampolini M. [I.V. ketorolac in the therapy of postoperative pain]. Giornale di Chirurgia 11: 243–246, 1990PubMedGoogle Scholar
  35. Edwards ND, Barclay K, Catling SJ, Martin DG, Morgan RH. Day case laparoscopy: a survey of postoperative pain and an assessment of the value of diclofenac. Anaesthesia 46: 1077–1080, 1991PubMedGoogle Scholar
  36. Engel C, Lund B, Kristensen SS, Axel C, Nielsen JB. Indometh-acin as an analgesic after hysterectomy. Acta Anaesthesiologica Scandinavia 33: 498–501, 1989Google Scholar
  37. Folsland B, Skulberg A, Halvorsen P, Helgesen KG. Placebo-controlled comparison of single intramuscular doses of ketorolac tromethamine and pethidine for post-operative analgesia. Journal of International Medical Research 18: 305–314, 1990PubMedGoogle Scholar
  38. Foster JMG, Cashman JN, Jones RM. Parenteral aspirin for pain relief in day-case dental anaesthesia: a randomised double blind placebo controlled trial. Anaesthesia 40: 576–578, 1985PubMedGoogle Scholar
  39. Gilles GWA, Kenny GNC, Bullingham RES, McArdle CS. The morphine sparing effect of ketorolac tromethamine. Anaesthesia 42: 727–731, 1987Google Scholar
  40. Goldberg MA, McLaughlin GG, Kieffer DA, Stern L, Hirose H, et al. Naproxen sodium: comparative efficacy and tolerability of two dosages for pain after joint surgery [published erratum appears in Orthopedics 11: 949, 1988]. Orthopedics 11: 575–880, 1988PubMedGoogle Scholar
  41. Goucke CR, Keaveny JP, Kay B, Healy TE, Ryan M. The effect of diclofenac and nefopam on postoperative dental pain. Anaesthesia 45: 329–331, 1990PubMedGoogle Scholar
  42. Gwirtz KH, Helvie JE, Young JV, Li W. Ketorolac enhances in-trathecal analgesia after major abdominal and orthopedic surgery. Regional Anesthesia 17: 161, 1992Google Scholar
  43. Heard SO, Edwards WT, Ferrari D, et al. Analgesic effect of in-traarticular bupivacaine or morphine after arthroscopic knee surgery: a randomized, prospective double-blind study. Anesthesia and Analgesia 74: 822–826, 1992PubMedGoogle Scholar
  44. Hill CM, Carroll MJ, Giles AD, Pickvance N. Ibuprofen given pre- and post-operatively for the relief of pain. International Journal of Oral and Maxillofacial Surgery 16: 420–424, 1987PubMedGoogle Scholar
  45. Hodsman NB, Burns J, Blyth A, Kenny GN, McArdle CS, et al. The morphine sparing effects of diclofenac sodium following abdominal surgery. Anaesthesia 42: 1005–1008, 1987PubMedGoogle Scholar
  46. Hutchinson GL, Crofts SL, Gray IG. Preoperative piroxicam for postoperative analgesia in dental surgery. British Journal of Anaesthesia 65: 500–503, 1990Google Scholar
  47. Jackson DL, Moore PA, Hargreaves KM. Preoperative nonster-oidal anti-inflammatory medication for the prevention of postoperative dental pain. Journal of the American Dental Association 119: 641–647, 1989PubMedGoogle Scholar
  48. Jones RM, Cashman JN, Foster JM, Wedley JR, Adams AP. Comparison of infusions of morphine and lysine acetyl sali-cylate for the relief of pain following thoracic surgery. British Journal of Anaesthesia 57: 259–263, 1985PubMedGoogle Scholar
  49. Joris J, Sferlazza A, Van Erk J, Lamy M. Patient-controlled analgesia with opiate is not significantly influenced by programmation, choice of narcotics and combination with a minor analgesic. Regional Anesthesia 17: 153, 1992Google Scholar
  50. Kavanagh BP, Katz J, Sandler AN, Nierenberg H, Panos L. Pre-incisional versus post-incisional lumbar epidural fentanyl reduces pain following thoracic surgery: a randomized double-blind crossover study. Anesthesiology 75: A1087, 1991Google Scholar
  51. Keenan DJM, Cave K, Langdon L, Lea RE. Comparative trial of indomethacin and cryoanalgesia for the control of early post thoracotomy pain. British Medical Journal 287: 1335–1337, 1983PubMedGoogle Scholar
  52. Kenny GN. Ketorolac trometamol — a new non-opioid analgesic [editorial]. British Journal of Anaesthesia 65: 445–447, 1990PubMedGoogle Scholar
  53. Kerri-Szanto M, Heaman S. Postoperative demand analgesia. Surgery, Gynecology and Obstetrics 134: 647, 1972Google Scholar
  54. Koffer H, Hildebrand III JR, Connell ML. Potential for nonnar-cotic analgesics to save personnel costs associated with controlling injectable morphine and meperidine. American Journal of Hospital Pharmacy 47: 1084–1088, 1990PubMedGoogle Scholar
  55. Kuhn S, Cooke K, Collins M, Jones JM, Mucklow JC. Perceptions of pain relief after surgery. British Medical Journal 300: 1687–1690, 1990PubMedGoogle Scholar
  56. Kweekel-de Vries W, Spierdijk J, Mattie H, Hermans JM. A new soluble acetylsalicylic acid derivative in the treatment of postoperative pain. British Journal of Anaesthesia 46: 133–135, 1974PubMedGoogle Scholar
  57. Laitinen J, Nuutinen L. Failure of transcutaneous electrical stimulation and indomethacin to reduce opiate requirement following cholecystectomy. Acta Anaesthesiologica Scandinav-ica 35: 700–705, 1991Google Scholar
  58. Laitinen J, Nuutinen L. Intravenous diclofenac coupled with PCA fentanyl for pain relief after total hip replacement. Anesthesiology 76: 194–198, 1992PubMedGoogle Scholar
  59. Laitinen J, Nuutinen L, Kiiskila EL, Freudenthal Y, Ranta P, et al. Comparison of intravenous diclofenac, indomethacin and oxycodone as postoperative analgesics in patients undergoing knee surgery. European Journal of Anaesthesiology 9: 29–34, 1992PubMedGoogle Scholar
  60. Lee VC. Non-narcotic modalities for the management of acute pain. Critical Care Clinics 6: 451–481, 1990PubMedGoogle Scholar
  61. Lindgren U, Djupsjo H. Diclofenac for pain after hip surgery. Acta Orthopaedica Scandinavica 56: 28–31, 1985PubMedGoogle Scholar
  62. Loper KA, Ready LB, Downey MEA. Epidural and intravenous fentanyl infusions are clinically equivalent following knee surgery. Anesthesia and Analgesia 70: 72–75, 1990PubMedGoogle Scholar
  63. Lowen WB, Morrison JD. The incidence and severity of postoperative pain. British Journal of Anaesthesia 39: 695–698, 1967Google Scholar
  64. MacDonald FC, Gough KJ, Nicoll RA, Dow RJ. Psychomotor effects of ketorolac in comparison with buprenorphine and diclofenac. British Journal of Clinical Pharmacology 27: 453–459, 1989PubMedGoogle Scholar
  65. MacLennan AH, Rodrigues LV, Krutli DR, Klomp A. Postoperative discomfort after ring or clip tubal ligation — is there any difference and do indomethacin suppositories help? Contraception 42: 309–313, 1990PubMedGoogle Scholar
  66. McGlew IC, Angliss DB, Gee GJ, Rutherford A, Wood ATA. A comparison of rectal indomethacin with placebo for pain relief following spinal surgery. Anaesthesia and Intensive Care 19: 40–45, 1991PubMedGoogle Scholar
  67. McLoughlin C, McKinney MS, Fee JPH, Boules Z. Diclofenac for day-care arthroscopy surgery: comparison with a standard opioid therapy. British Journal of Anaesthesia 65: 620–623, 1990PubMedGoogle Scholar
  68. McQuay HJ, Carroll D, Moore RA. Postoperative orthopaedic pain the effect of opiate premedication and local anaesthetic blocks. Pain 33: 291–295, 1988PubMedGoogle Scholar
  69. Melzack R. The tragedy of needless pain. Scientific American 262: 27–33, 1990PubMedGoogle Scholar
  70. Michaelides S, Pappas X, Pouliou K, Pagouni C, Gregooropoulu J, et al. Comparative evaluation of the effects of morphine and ketorolac on gas exchange in elderly postoperative patients. Regional Anesthesia 17: 154, 1992Google Scholar
  71. Minutello JS, Newell DH, Thrash WJ, Terezhalmy GT. Evaluation of preoperative diflunisal for postoperative pain following periodontal surgery. Journal of Periodontology 59: 390–393, 1988PubMedGoogle Scholar
  72. Minutello JS, Newell DH, Thrash WJ, Terezhalmy GT. Evaluation of postoperative diflunisal for periodontal surgery pain. American Journal of Dentistry 4: 33–36, 1991PubMedGoogle Scholar
  73. Moffat AC, Kenny GN, Prentice JW. Postoperative nefopam and diclofenac. Evaluation of their morphine-sparing effect after upper abdominal surgery. Anaesthesia 45: 302–305, 1990PubMedGoogle Scholar
  74. Murray AW, Brockway MS, Kenny GNC. Comparison of the car-diorespiratory effects of ketorolac and alfentanil during pro-pofol anaesthesia. British Journal of Anaesthesia 63: 601–603, 1989PubMedGoogle Scholar
  75. Norvell MJ, McAllister JC, Bailey E. Cost analysis of drug distribution for controlled substances. American Journal of Hospital Pharmacy 40: 801–807, 1983Google Scholar
  76. O’Hara DA, Fragen RJ, Kinzer M, Pemberton D. Ketorolac tro-methamine as compared with morphine sulfate for treatment of postoperative pain. Clinical Pharmacology and Therapeutics 41: 556–561, 1987PubMedGoogle Scholar
  77. Oden RV. Acute postoperative pain: incidence, severity, and the etiology of inadequate treatment. Anesthesiology Clinics of North America 7: 1–15, 1989Google Scholar
  78. Owen H, Glavin RJ, Shaw NA. Ibuprofen in the management of postoperative pain. British Journal of Anaesthesia 58: 1371–1375, 1986PubMedGoogle Scholar
  79. Palazzo MGA, Strunin L. Anaesthesia and emesis. II: prevention and management. Canadian Anaesthesia Society Journal 31: 407–415, 1984Google Scholar
  80. Pandit SK, Kothary SP, Lebenbom-Mansour M, et al. Failure of ketorolac to prevent severe postoperative pain following outpatient laparoscopy. Anesthesiology 75: A33, 1991Google Scholar
  81. Pavy T, Medley C, Murphy DF. Effect of indomethacin on pain relief after thoracotomy. British Journal of Anaesthesia. 65: 624–627, 1990PubMedGoogle Scholar
  82. Powell H, Smallman JMB, Morgan M. Comparison of intramuscular ketorolac and morphine in pain control after lapa-rotomy. Anaesthesia 45: 538–542, 1990PubMedGoogle Scholar
  83. Power I, Noble DW, Douglas E, Spence AA. Comparison of i.m. ketorolac trometamol and morphine sulphate for pain relief after cholecystectomy. British Journal of Anaesthesia 65: 448–455, 1990PubMedGoogle Scholar
  84. Prados W, Blaylock S. The effect of ketorolac on the postoperative narcotic requirements of gynecological surgery outpatients. Anesthesiology 75: A5, 1991Google Scholar
  85. Reasbeck PG, Rice ML, Reasbeck JC. Double-blind controlled trial of indomethacin as an adjunct to narcotic analgesia after major abdominal surgery. Lancet. 2: 115–118, 1982PubMedGoogle Scholar
  86. Reynolds RC, Ploetz P, Thielke TS. Comparative analysis of drug distribution costs for controlled versus noncontrolled oral analgesics. American Journal of Hospital Pharmacy 41: 1558–1563, 1984PubMedGoogle Scholar
  87. Rhodes M, Conacher I, Morritt G, Hilton C. Nonsteroidal an-tiinflammatory drugs for post thoracotomy pain. A prospective controlled trial after lateral thoracotomy. Journal of Thoracic and Cardiovascular Surgery 103: 17–20, 1992PubMedGoogle Scholar
  88. Rooney ME, Code WE. Can the NSAID naproxen reduce postoperative pain in laparoscopic tubal ligation? Anesthesia and Analgesia 72 (Suppl.): 227, 1991Google Scholar
  89. Rosenblum M, Weller RS, Conard P, Falvey E, Gross JB. Ibu-profen provides better analgesia than fentanyl following laparoscopic surgery. Anesthesiology 73: A777, 1990Google Scholar
  90. Rubin P, Yee JP, Murthy VS, Seavey W. Ketorolac trometham-ine (KT) analgesia: no post-operative depression and less constipation. Clinical Pharmacology and Therapeutics 41: 182, 1987Google Scholar
  91. Sandier AN, Baxter MB, Norman P, Samson B, Freidlander MB. Double-blind placebo-controlled trial of transdermal fentanyl for post-hysterectomy analgesia. Anaesthesiology 75: A707, 1991Google Scholar
  92. Schulze S, Moller IW, Bang U, Rye B, Kehlet H. Effect of combined prednisolone, epidural analgesia and indomethacin on pain, systemic response and convalescence after cholecystec-tomy. Acta Chirurgica Scandinavica 156: 203–209, 1990PubMedGoogle Scholar
  93. Schulze S, Roikjaer O, Hasselstrom L, Jensen NH, Kehlet H. Epidural bupivacaine and morphine plus systemic indomethacin eliminates pain but not systemic response and convalescence after cholecystectomy. Surgery 103: 321–327, 1988PubMedGoogle Scholar
  94. Segstro R, Morley-Forster PK, Lu G. Indomethacin as a postoperative analgesic for total hip arthroplasty. Canadian Journal of Anaesthesia 38: 578–581, 1991PubMedGoogle Scholar
  95. Semple P, Jackson IJ. Postoperative pain control: a survey of current practice. Anaesthesia 46: 1074–1076, 1991PubMedGoogle Scholar
  96. Serpell MG, Thomson MF. Comparison of piroxicam with placebo in the management of pain after total hip replacement. British Journal of Anaesthesia 63: 354–356, 1989PubMedGoogle Scholar
  97. Sevarino FB, Ning T, Sinatra RS, Silverman DG, Brull SJ. The efficacy of ketorolac 15 mg or 30 mg in combination with morphine PCA in postoperative gynecological surgery patients. Anesthesiology. 75: A1089, 1991Google Scholar
  98. Seymour RA. Use of analgesics in postoperative dental pain: a review. Journal of the Royal Society of Medicine 77: 949–954, 1984PubMedGoogle Scholar
  99. Sisk AL, Mosley RO, Martin RP. Comparison of preoperative and postoperative diflunisal for suppression of postoperative pain. Journal of Oral and Maxillofacial Surgery 47: 464–468, 1989PubMedGoogle Scholar
  100. Sisk AL, Grover BJ. A comparison of preoperative and postoperative naproxen sodium for suppression of postoperative pain. Journal of Oral and Maxillofacial Surgery 48: 674–678, 1990PubMedGoogle Scholar
  101. Smith I, Van Hemelrijck J, White PF. Effects of local anesthesia on recovery after outpatient arthroscopy. Anesthesia and Analgesia 73: 536–539, 1991PubMedGoogle Scholar
  102. Sriwantanakul K, Weis OF, Alloza JL, Kelvie W, Weintraub M, et al. Analysis of narcotic analgesic usage in the treatment of post-operative pain. Journal of the American Medical Association 250: 926–929, 1983Google Scholar
  103. Stapleton JA, Austin KL, Mather LE. A pharmacokinetic approach to postoperative pain: continuous infusion of pethi-dine. Anaesthesia and Intensive Care 7: 25–32, 1979PubMedGoogle Scholar
  104. Sun HL, Cheng KW, Chien CC, Che CJ, Chang CF. Diclofenac sodium and low dose epidural morphine for postcesarean analgesia. Ma Tsui Hsueh Tsa Chi 28: 295–301, 1990PubMedGoogle Scholar
  105. Thind P, Sigsgaard T. The analgesic effect of indomethacin in the early post-operative period following abdominal surgery. A double-blind controlled study. Acta Chirurgica Scandinavica 154: 9–12, 1988PubMedGoogle Scholar
  106. Tigerstedt I, Tammisto T, Neuvonen PJ. The efficacy of intravenous indomethacin in prevention of postoperative pain. Acta Anaesthesiologica Scandinavica 35: 535–540, 1991PubMedGoogle Scholar
  107. Twiston-Davies C, Goodwin MI, Baxter PJ. Rectal indomethacin for postoperative pain in orthopaedic surgery. A double-blind study. Journal of Bone and Joint Surgery — British Volume 72: 510–511, 1990Google Scholar
  108. Van Wijk MG, Smalhout B. A postoperative analysis of the patient’s view of anaesthesia in a Netherlands teaching hospital. Anaesthesia 45: 679–682, 1990PubMedGoogle Scholar
  109. Wall PD. The prevention of postoperative pain. Pain 33: 289–290, 1988PubMedGoogle Scholar
  110. Watt-Watson JH. Nurses knowledge of pain issues: a survey. Journal of Pain Symptom Management 2: 207–211, 1987Google Scholar
  111. Weis OF, Alloza JL, Weintrub M, Lasagna L. Attitudes of patients, housestaff, and nurses toward post-operative analgesic care. Anesthesia and Analgesia 62: 70–74, 1983PubMedGoogle Scholar
  112. White PF. Current and future trends in acute pain management. Clinical Journal of Pain 5(Suppl.): 51–58, 1989Google Scholar
  113. Wool C, Prandoni P, Polistena P, Ruol A. Ketorolac suppositories in the treatment of neoplastic pain: a randomized clinical trial versus diclofenac. Current Therapeutic Research 49: 854–861, 1991Google Scholar
  114. Wuolijoki E, Oikarinen VJ, Ylipaavalniemi P, Hampf G, Tolvanen M. Effective postoperative pain control by preoperative injection of diclofenac. European Journal of Clinical Pharmacology 32: 249–252, 1987PubMedGoogle Scholar
  115. Yee JP, Koshiver JE, Allbon C, Brown CR. Comparison of intramuscular ketorolac tromethamine and morphine sulfate for analgesia of pain after major surgery. Pharmacotherapy 6: 253–261, 1986PubMedGoogle Scholar
  116. Yee MK, Evans WD, Facey PE, Hayward MWJ, Rosen M. Gastric emptying and small bowel transit in male volunteers after i.m. ketorolac and morphine. British Journal of Anaesthesia 67: 426–431, 1991PubMedGoogle Scholar
  117. Young ML, Kitz DS, Conahan TJ, Aukburg SJ, Lecky JH. Postoperative mood assessment in surgical outpatients: impact of vomiting and pain. Anesthesiology 75: A6, 1991Google Scholar

Copyright information

© Adis International Limited 1992

Authors and Affiliations

  • Carol Moote
    • 1
  1. 1.Department of AnaesthesiaUniversity HospitalLondonCanada

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