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Ketorolac in the treatment of acute migraine: a systematic review

Bibliographic details: Taggart E, Doran S, Kokotillo A, Campbell S, Villa-Roel C, Rowe BH.  Ketorolac in the treatment of acute migraine: a systematic review. Headache 2013; 53(2): 277-287

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

[Increased risk of hemorrhagic complications and the use of ketorolac related to post-surgical thromboprophylaxis]

Bibliographic details: Martinez Granados F, Martinez Lazcano M T, Navarro Polo J N, Ordovas Baines J P.  [Increased risk of hemorrhagic complications and the use of ketorolac related to post-surgical thromboprophylaxis]. [Riesgo aumentado de complicaciones hemorragicas y uso de ketorolaco asociado a tromboprofilaxis postquirurgica.] Atencion Farmaceutica 2007; 9(5): 298-306

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Ketorolac for Pain Management: A Review of the Clinical Evidence [Internet]

Non-steroidal anti-inflammatory drugs (NSAIDs) play an important role in the pain management in various clinical conditions such as headaches, menstrual disorders, postoperative pain, spinal and soft tissue pain, rheumatoid arthritis (RA), osteoarthritis (OA), and ankylosing spondylitis (AS) by blocking cyclooxygenase (COX) enzymes that are needed to produce prostaglandin.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: June 30, 2014
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Ketorolac therapy for the prevention of acute pseudophakic cystoid macular edema: a systematic review

To assess the effectiveness of ketorolac vs control for prevention of acute pseudophakic cystoid macular edema (CME). The following databases were searched: Medline (1950-June 11, 2011), The Cochrane Library (Issue 2, 2011), and the TRIP Database (up to 11 June 2011), using no language or other limits. Randomized controlled clinical trials (RCTs) were included that consisted of patients with acute pseudophakic cystoid macular edema, those comparing ketorolac with control, and those having at least a minimum follow-up of 28 days. In the four RCTs evaluating ketorolac vs control, treatment with ketorolac significantly reduced the risk of CME development at the end of treatment (≈ 4 weeks) compared to control (P=0.008; 95% confidence interval (0.03-0.58)). When analyzed individually, each individual study was statistically nonsignificant in its findings with the exception of one study. When the pooled relative risk was calculated, the large sample size of this systematic review led to overall statistical significance, which is attributable to the review's large sample size and not to the individual studies themselves. In this systematic review of four RCTs, two of which compared ketorolac with no treatment and two of which evaluated ketorolac vs placebo drops, treatment with ketorolac significantly reduced the risk of developing CME at the end of ≈ 4 weeks of treatment compared with controls. These results, however, should be interpreted with caution considering the paucity of large randomized clinical trials in the literature.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Perioperative ketorolac increases post-tonsillectomy hemorrhage in adults, but not children

OBJECTIVES/HYPOTHESIS: To evaluate the risk of post-tonsillectomy hemorrhage associated with perioperative ketorolac use.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Ketorolac does not increase perioperative bleeding: a meta-analysis of randomized controlled trials

BACKGROUND: Postoperative pain control is essential for optimal patient outcomes. Ketorolac is an attractive alternative for achieving pain control postoperatively, but concerns over postoperative bleeding have limited its use.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

High-dose ketorolac affects adult spinal fusion: a meta-analysis of the effect of perioperative nonsteroidal anti-inflammatory drugs on spinal fusion

STUDY DESIGN: Meta-analysis of literature.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Perioperative single dose ketorolac to prevent postoperative pain: a meta-analysis of randomized trials

The review concluded that single-dose ketorolac was effective to reduce post-operative pain as well as post-operative nausea and vomiting. However, interpretation of the data may have been limited by variation amongst studies and unclear study quality. The authors' conclusions reflect the presented evidence but in light of the mentioned limitations their conclusions should be interpreted carefully.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care

This guideline has been developed to advise on supporting people with dementia and their carers in health and social care. The guideline recommendations have been developed by a multidisciplinary team of health and social care professionals, a person with dementia, carers and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to practitioners and service commissioners in providing and planning high-quality care for those with dementia while also emphasising the importance of the experience of care for people with dementia and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2007
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Analgesics for Osteoarthritis: An Update of the 2006 Comparative Effectiveness Review [Internet]

To update a previous report on the comparative benefits and harms of oral non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, over-the-counter supplements (chondroitin and glucosamine), and topical agents (NSAIDs and rubefacients, including capsaicin) for osteoarthritis.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: October 2011
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Drug Class Review: Nonsteroidal Antiinflammatory Drugs (NSAIDs): Final Update 4 Report [Internet]

We compared the effectiveness and harms of oral or topical nonsteroidal antiinflammatory drugs (NSAIDs) in the treatment of chronic pain from osteoarthritis, rheumatoid arthritis, soft tissue pain, back pain, and ankylosing spondylitis.

Drug Class Reviews - Oregon Health & Science University.

Version: November 2010
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Acute Migraine Treatment in Emergency Settings [Internet]

To compare the effectiveness and safety of parenteral pharmacological interventions to treat migraine headaches in adults presenting to the emergency department (ED).

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: November 2012
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Patients' global evaluation of analgesia and safety of injected parecoxib for postoperative pain: a quantitative systematic review

Parecoxib is the only parenterally administered cyclooxygenase-2-selective inhibitor available. We performed a systematic review, including full reports of randomized comparisons of parecoxib compared with any other analgesic intervention for prophylaxis or treatment of postoperative pain. Dichotomous data on patients' global evaluation of their analgesic regimen were extracted by means of the fraction of patients who rated their medication as "good" or "excellent." For safety analysis, data on any reported adverse effects were extracted. Relative risk (RR), number needed to treat (NNT), or number-needed-to-harm were calculated with 95% confidence intervals (CI). Data from 9 trials of 50 initially screened were finally analyzed. One thousand thirteen patients were randomized to receive parecoxib, 218 patients were allocated to an active control, and 507 patients received a placebo. With prophylactic administration, the pooled NNT to obtain the desired outcome ("good"/"excellent" rating) with parecoxib 20 and 40 mg compared with placebo was 4.5 (RR, 1.42; 95% CI, 0.91-2.24) and 4.0 (RR, 1.40; 95% CI, 1.10-1.79), respectively. In the treatment trials, the NNT to obtain the outcome of interest with parecoxib 20 mg was 2.1 (RR, 3.44; 95% CI, 1.49-7.96), 5.3 (RR, 1.43; 95% CI, 1.01-2.02), and -8.3 (RR, 0.85; 95% CI, 0.75-0.97) for the comparisons with placebo, morphine, and ketorolac, respectively. The corresponding NNT for treatment with parecoxib 40 mg was 1.7 (RR, 4.65; 95% CI, 2.04-10.61), 3.7 (RR, 1.62; 95% CI, 1.21-2.16), and 50 (RR, 1.03; 95% CI, 0.89-1.18) for the comparisons with placebo, morphine, and ketorolac, respectively. Overall adverse effects for parecoxib 20 and 40 mg were not different from those with placebo, morphine, or ketorolac. These results suggest a favorable profile for parecoxib compared with inactive or active controls. The optimal dose, timing, and frequency of administration need to be determined.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

Non-narcotic adjuvants may improve the duration and quality of analgesia after knee arthroscopy: a brief review

This review assessed whether intra-articular non-narcotic adjuvants improved the duration of analgesia after arthroscopic knee surgery. The authors concluded that intra-articular clonidine and ketorolac may reduce post-operative pain. Overall, the authors' conclusions are consistent with the evidence reviewed, but the magnitude of any treatment effect is unclear given the lack of detail reported in the results.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

Local infiltration analgesia for postoperative pain control following total hip arthroplasty: a systematic review

Local infiltration analgesia (LIA) is an analgesic technique that has gained popularity since it was first brought to widespread attention by Kerr and Kohan in 2008. The technique involves the infiltration of a large volume dilute solution of a long-acting local anesthetic agent, often with adjuvants (e.g., epinephrine, ketorolac, an opioid), throughout the wound at the time of surgery. The analgesic effect duration can then be prolonged by the placement of a catheter to the surgical site for postoperative administration of further local anesthetic. The technique has been adopted for use for postoperative analgesia following a range of surgical procedures (orthopedic, general, gynecological, and breast surgeries). The primary objective of this paper was to determine, based on the current evidence, if LIA is superior when compared to no intervention, placebo, and alternative analgesic methods in patients following total hip arthroplasty, in terms of certain outcome measures. The outcomes considered were postoperative analgesia scores, joint function/rehabilitation, and length of hospital stay. Secondary objectives were to review available evidence and current knowledge regarding the pharmacokinetics of local anesthetic and adjuvant drugs when administered in this way and the occurrence of adverse events.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Non‐steroidal anti‐inflammatory drugs for treating fluid accumulation in the macula after cataract surgery

Cystoid macular oedema (CMO) is the accumulation of fluid in the macula (central retina) due to leakage from capillaries. Clinically significant CMO following cataract surgery is a complication of unknown cause. Acute CMO, defined as oedema of less than four months duration, often gets better spontaneously. This review included seven randomised controlled trials with a total of 266 participants. Four trials studied the effects of non‐steroidal anti‐inflammatory agents (NSAIDs) in chronic CMO while the other three examined the effect of NSAIDs in acute CMO. This review found two trials which showed that topical NSAID (0.5% ketorolac tromethamine ophthalmic solution) has a positive effect on chronic CMO and a third trial which was supportive of this finding (albeit not statistically significantly so). One study suggested no effect and our review suggests further work is needed for a more conclusive decision regarding use of NSAIDS in chronic CMO. Similarly, the effects of NSAIDs in acute CMO remain unclear and this too needs further investigation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Canadian Headache Society systematic review and recommendations on the treatment of migraine pain in emergency settings

BACKGROUND: There is a considerable amount of practice variation in managing migraines in emergency settings, and evidence-based therapies are often not used first line.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

[Systematic review to assess the effectiveness and safety of parecoxib]

OBJECTIVES: Conduct a meta-analysis of randomized clinical trials to assess the effectiveness and safety of parecoxib as analgesic for orthopedic surgery.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Evidence-based postoperative pain management after laparoscopic colorectal surgery

AIM: The aim of this systematic review was to evaluate the available literature on the management of pain after laparoscopic colorectal surgery.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

A systematic review of postoperative analgesia following laparoscopic colorectal surgery

This review found there was a paucity of research and no clear evidence that one postoperative analgesic regime was superior to another following laparoscopic colorectal surgery. Given the lack of information provided for the results and the potential for various biases, the results of the review should be interpreted with caution and the reliability of the authors' conclusions is unclear.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Systematic Reviews in PubMed

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