酮咯酸镇痛专家共识
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摘要
<正>疼痛作为体温、脉搏、血压、呼吸之后的第五大生命体征[1],是实质或潜在的组织损伤所引起的不愉快感觉和情感体验,或是具有感觉、情绪、认知和社会层面的痛苦体验。手术后疼痛常在手术结束或麻醉作用消失后即刻发生,通常不超过3～7 d。目前国内外术后镇痛不足普遍存在,如不能得到有效控制,部分患者可能发展为慢性疼痛,将严重影响患者的康复和生活质量[2]。此外,晚期癌症患者常伴有中、重度疼痛。临床控制围术期中、重度疼痛常用的药物包括阿片类药物及非
引文
[1] Fishman SM.Pain as the fifth vital sign:how can I tell when back pain is serious.J Pain Palliat Care Pharmacother,2005,19(4):77-79.
[2] 邓小明,姚尚龙,于布为,等.现代麻醉学.第4版.北京:人民卫生出版社,2311.
[3] Harirforoosh S,Jamali F.Renal adverse effects of nonsteroidal anti-inflammatory drugs.Expert Opin Drug Saf,2009,8(6):669-681.
[4] Vadivelu N,Gowda AM,Urman RD,et al.Ketorolac tromethamine-routes and clinical implications.Pain Pract,2015,15(2):175-193.
[5] Brocks DR,Jamali F.Clinical pharmacokinetics of ketorolac tromethamine.Clin Pharmacokinet,1992,23(6):415-427.
[6] Langenbach R,Morham SG,Tiano HF,et al.Prostaglandin synthase 1 gene disruption in mice reduces arachidonic acid-induced inflammation and indomethacin-induced gastric ulceration.Cell,1995,83(3):483-492.
[7] Chou R,Gordon DB,de Leon-Casasola OA,et al.Management of postoperative pain:a clinical practice guideline from the American Pain Society,the American Society of Regional Anesthesia and Pain Medicine,and the American Society of Anesthesiologists' Committee on Regional Anesthesia,Executive Committee,and Administrative Council.J Pain,2016,17(2):131-157.
[8] Lin XH,Young SH,Luo JC,et al.Risk factors for upper gastrointestinal bleeding in patients taking selective COX-2 inhibitors:a nationwide population-based cohort study.Pain Med,2018,19(2):225-231.
[9] N?rregaard R,Kwon TH,Fr?ki?r J.Physiology and pathophysiology of cyclooxygenase-2 and prostaglandin E2 in the kidney.Kidney Res Clin Pract,2015,34(4):194-200.
[10] Kulkarni SK,Jain NK,Singh A.Cyclooxygenase isoenzymes and newer therapeutic potential for selective COX-2 inhibitors.Methods Find Exp Clin Pharmacol,2000,22(5):291-298.
[11] Norman PH,Daley MD,Lindsey RW.Preemptive analgesic effects of ketorolac in ankle fracture surgery.Anesthesiology,2001,94(4):599-603.
[12] Cansino C,Edelman A,Burke A,et al.Paracervical block with combined ketorolac and lidocaine in first-trimester surgical abortion:a randomized controlled trial.Obstet Gynecol,2009,114(6):1220-1226.
[13] Lu CH,Liu JY,Lee MS,et al.Preoperative cotreatment with dextromethorphan and ketorolac provides an enhancement of pain relief after laparoscopic-assisted vaginal hysterectomy.Clin J Pain,2006,22(9):799-804.
[14] Yadav M,Grewal MS,Grewal S,et al.Comparison of preoperative oral ketorolac on anesthetic efficacy of inferior alveolar nerve block and buccal and lingual infiltration with articaine and lidocaine in patients with irreversible pulpitis:a prospective,randomized,controlled,double-blind Study.J Endod,2015,41(11):1773-1777.
[15] Ong KS,Seymour RA,Chen FG,et al.Preoperative ketorolac has a preemptive effect for postoperative third molar surgical pain.Int J Oral Maxillofac Surg,2004,33(8):771-776.
[16] Kim SK,Hong JP,Nam SM,et al.Analgesic effect of preoperative topical nonsteroidal antiinflammatory drugs on postoperative pain after laser-assisted subepithelial keratectomy.J Cataract Refract Surg,2015,41(4):749-755.
[17] Stanski DR,Cherry C,Bradley R,et al.Efficacy and safety of single doses of intramuscular ketorolac tromethamine compared with meperidine for postoperative pain.Pharmacotherapy,1990,10(6):40S-44S.
[18] O'hara DA,Fragen RJ,Kinzer M,et al.Ketorolac tromethamine as compared with morphine sulfate for treatment of postoperative pain.Clin Pharmacol Ther,1987,41(5):556-561.
[19] Picard P,Bazin JE,Conio N,et al.Ketorolac potentiates morphine in postoperative patient-controlled analgesia.Pain,1997,73(3):401-406.
[20] Power I,Bowler GM,Pugh GC,et al.Ketorolac as a component of balanced analgesia after thoracotomy.Br J Anaesth,1994,72(2):224-226.
[21] Singh H,Bossard RF,White PF,et al.Effects of ketorolac versus bupivacaine coadministration during patient-controlled hydromorphone epidural analgesia after thoracotomy procedures.Anesth Analg,1997,84(3):564-569.
[22] Axelsson K,Gupta A,Johanzon E,et al.Intraarticular administration of ketorolac,morphine,and ropivacaine combined with intraarticular patient-controlled regional analgesia for pain relief after shoulder surgery:a randomized,double-blind study.Anesth Analg,2008,106(1):328-333.
[23] Kim TW,Park SJ,Lim SH,et al.Which analgesic mixture is appropriate for periarticular injection after total knee arthroplasty?Prospective,randomized,double-blind study.Knee Surg Sports Traumatol Arthrosc,2015,23(3):838-845.
[24] Cassinelli EH,Dean CL,Garcia RM,et al.Ketorolac use for postoperative pain management following lumbar decompression surgery:a prospective,randomized,double-blinded,placebo-controlled trial.Spine,2008,33(12):1313-1317.
[25] Lowder JL,Shackelford DP,Holbert D,et al.A randomized,controlled trial to compare ketorolac tromethamine versus placebo after cesarean section to reduce pain and narcotic usage.Am J Obstet Gynecol,2003,189(6):1559-1562.
[26] Russo A,Di Stasio E,Bevilacqua F,et al.Efficacy of scheduled time ketorolac administration compared to continuous infusion for post-operative pain after abdominal surgery.Eur Rev Med Pharmacol Sci,2012,16(12):1675-1679.
[27] Mesen TB,Kacemi-Bourhim L,Marshburn PB,et al.The effect of ketorolac on pregnancy rates when used immediately after oocyte retrieval.Fertil Steril,2013,100(3):725-728.
[28] 章壮云,胡建,刘耿,等.地佐辛复合酮咯酸氨丁三醇术后PCIA的效果及对血清五羟色胺和P物质的影响.临床麻醉学杂志,2013,29(9):863-866.
[29] R?msing J,Ostergaard D,Walther-Larsen S,et al.Analgesic efficacy and safety of preoperative versus postoperative ketorolac in paediatric tonsillectomy.Acta Anaesthesiol Scand,1998,42(7):770-775.
[30] Jo YY,Hong JY,Choi EK,et al.Ketorolac or fentanyl continuous infusion for post-operative analgesia in children undergoing ureteroneocystostomy.Acta Anaesthesiol Scand,2011,55(1):54-59.
[31] Stricker PA,Muhly WT,Jantzen EC,et al.Intramuscular fentanyl and ketorolac associated with superior pain control after pediatric bilateral myringotomy and tube placement surgery:a retrospective cohort study.Anesth Analg,2017,124(1):245-253.
[32] Sucato DJ,Lovejoy JF,Agrawal S,et al.Postoperative ketorolac does not predispose to pseudoarthrosis following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis.Spine,2008,33(10):1119-1124.
[33] Inoue M,Caldarone CA,Frndova H,et al.Safety and efficacy of ketorolac in children after cardiac surgery.Intensive Care Med,2009,35(9):1584-1592.
[34] Gupta A,Daggett C,Drant S,et al.Prospective randomized trial of ketorolac after congenital heart surgery.J Cardiothorac Vasc Anesth,2004,18(4):454-457.
[35] Cepeda MS,Carr DB,Miranda N,et al.Comparison of morphine,ketorolac,and their combination for postoperative pain:results from a large,randomized,double-blind trial.Anesthesiology,2005,103(6):1225-1232.
[36] Zackova M,Taddei S,Calò P,et al.Ketorolac vs tramadol in the treatment of postoperative pain during maxillofacial surgery.Minerva Anestesiol,2001,67(9):641-646.
[37] Bakr MA,Amr SA,Mohamed SA,et al.Comparison between the effects of intravenous morphine,tramadol and ketorolac on stress and immune responses in patients undergoing modified radical mastectomy.Clin J Pain,2016,32(10):889-897.
[38] Lepri A,Sia S,Catinelli S,et al.Patient-controlled analgesia with tramadol versus tramadol plus ketorolac.Minerva Anestesiol,2006,72(1-2):59-67.
[39] Kim SY,Kim EM,Nam KH,et al.Postoperative intravenous patient-controlled analgesia in thyroid surgery:comparison of fentanyl and ondansetron regimens with and without the nonsteriodal anti-inflammatory drug ketorolac.Thyroid,2008,18(12):1285-1290.
[40] Olsen JC,Mcgrath NA,Schwarz DG,et al.A double-blind randomized clinical trial evaluating the analgesic efficacy of ketorolac versus butorphanol for patients with suspected biliary colic in the emergency department.Acad Emerg Med,2008,15(8):718-722.
[41] Hosseininejad SM,Amini Ahidashti H,Bozorgi F,et al.Efficacy and safety of combination therapy with ketorolac and morphine in patient with acute renal colic;a triple-blind randomized controlled clinical trial.Bull Emerg Trauma,2017,5(3):165-170.
[42] Motov S,Yasavolian M,Likourezos A,et al.Comparison of intravenous ketorolac at three single-dose regimens for treating acute pain in the emergency department:a randomized controlled trial.Ann Emerg Med,2017,70(2):177-184.
[43] Ortiz MI,Monroy-Maya R,Soto-Ríos M,et al.Effectiveness of diclofenac,ketorolac and etoricoxib in the treatment of acute pain from ankle fracture.Proc West Pharmacol Soc,2010,53:46-48.
[44] NCCN clinical practice guidelines in oncology-adult cancer pain(2018 Version 1).https://www.nccn.org.
[45] Staquet MJ.A double-blind study with placebo control of intramuscular ketorolac tromethamine in the treatment of cancer pain.J Clin Pharmacol,1989,29(11):1031-1036.
[46] Carlson RW,Borrison RA,Sher HB,et al.A multiinstitutional evaluation of the analgesic efficacy and safety of ketorolac tromethamine,acetaminophen plus codeine,and placebo in cancer pain.Pharmacotherapy,1990,10(3):211-216.
[47] Hughes A,Wilcock A,Corcoran R.Ketorolac:continuous subcutaneous infusion for cancer pain.J Pain Symptom Manage,1997,13(6):315-316.
[48] Mercadante S,Fulfaro F,Casuccio A.A randomised controlled study on the use of anti-inflammatory drugs in patients with cancer pain on morphine therapy:effects on dose-escalation and a pharmacoeconomic analysis.Eur J Cancer,2002,38(10):1358-1363.
[49] 王爱桃,姚尚龙,杜晓冰,等.酮咯酸氨丁三醇预防性镇痛对乳腺癌改良根治术患者镇痛效果及免疫功能的影响.临床麻醉学杂志,2016,32(11):1084-1086.
[50] Carvalho B,Lemmens HJ,Ting V,et al.Postoperative subcutaneous instillation of low-dose ketorolac but not hydromorphone reduces wound exudate concentrations of interleukin-6 and interleukin-10 and improves analgesia following cesarean delivery.J Pain,2013,14(1):48-56.
[51] Carney DE,Nicolette LA,Ratner MH,et al.Ketorolac reduces postoperative narcotic requirements.J Pediatric Surg,2001,36(1):76-79.
[52] 国家风湿数据中心,中国系统性红斑狼疮研究协作组.非甾体消炎药相关消化道溃疡与溃疡并发症的预防与治疗规范建议.中华内科杂志,2017,56(1):81-85.
[53] Harris SI,Kuss M,Hubbard RC,et al.Upper gastrointestinal safety evaluation of parecoxib sodium,a new parenteral cyclooxygenase-2-specific inhibitor,compared with ketorolac,naproxen,and placebo.Clin Ther,2001,23(9):1422-1428.
[54] Strom BL,Berlin JA,Kinman JL,et al.Parenteral ketorolac and risk of gastrointestinal and operative site bleeding.A postmarketing surveillance study.JAMA,1996,275(5):376-382.
[55] Flint J,Panchal S,Hurrell A,et al.BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part II:analgesics and other drugs used in rheumatology practice.Rheumatology,2016,55(9):1698-1702.
[56] Nielsen GL,S?rensen HT,Larsen H,et al.Risk of adverse birth outcome and miscarriage in pregnant users of non-steroidal anti-inflammatory drugs:population based observational study and case-control study.BMJ,2001,322(7281):266-270.
[57] K?llén BA,Otterblad Olausson P.Maternal drug use in early pregnancy and infant cardiovascular defect.Reprod Toxicol,2003,17(3):255-261.
[58] Bloor M,Paech M.Nonsteroidal anti-inflammatory drugs during pregnancy and the initiation of lactation.Anesth Analg,2013,116(5):1063-1075.
[59] Wischnik A,Manth SM,Lloyd J,et al.The excretion of ketorolac tromethamine into breast milk after multiple oral dosing.Eur J Clin Pharmacol,1989,36(5):521-524.
[2] 邓小明,姚尚龙,于布为,等.现代麻醉学.第4版.北京:人民卫生出版社,2311.
[3] Harirforoosh S,Jamali F.Renal adverse effects of nonsteroidal anti-inflammatory drugs.Expert Opin Drug Saf,2009,8(6):669-681.
[4] Vadivelu N,Gowda AM,Urman RD,et al.Ketorolac tromethamine-routes and clinical implications.Pain Pract,2015,15(2):175-193.
[5] Brocks DR,Jamali F.Clinical pharmacokinetics of ketorolac tromethamine.Clin Pharmacokinet,1992,23(6):415-427.
[6] Langenbach R,Morham SG,Tiano HF,et al.Prostaglandin synthase 1 gene disruption in mice reduces arachidonic acid-induced inflammation and indomethacin-induced gastric ulceration.Cell,1995,83(3):483-492.
[7] Chou R,Gordon DB,de Leon-Casasola OA,et al.Management of postoperative pain:a clinical practice guideline from the American Pain Society,the American Society of Regional Anesthesia and Pain Medicine,and the American Society of Anesthesiologists' Committee on Regional Anesthesia,Executive Committee,and Administrative Council.J Pain,2016,17(2):131-157.
[8] Lin XH,Young SH,Luo JC,et al.Risk factors for upper gastrointestinal bleeding in patients taking selective COX-2 inhibitors:a nationwide population-based cohort study.Pain Med,2018,19(2):225-231.
[9] N?rregaard R,Kwon TH,Fr?ki?r J.Physiology and pathophysiology of cyclooxygenase-2 and prostaglandin E2 in the kidney.Kidney Res Clin Pract,2015,34(4):194-200.
[10] Kulkarni SK,Jain NK,Singh A.Cyclooxygenase isoenzymes and newer therapeutic potential for selective COX-2 inhibitors.Methods Find Exp Clin Pharmacol,2000,22(5):291-298.
[11] Norman PH,Daley MD,Lindsey RW.Preemptive analgesic effects of ketorolac in ankle fracture surgery.Anesthesiology,2001,94(4):599-603.
[12] Cansino C,Edelman A,Burke A,et al.Paracervical block with combined ketorolac and lidocaine in first-trimester surgical abortion:a randomized controlled trial.Obstet Gynecol,2009,114(6):1220-1226.
[13] Lu CH,Liu JY,Lee MS,et al.Preoperative cotreatment with dextromethorphan and ketorolac provides an enhancement of pain relief after laparoscopic-assisted vaginal hysterectomy.Clin J Pain,2006,22(9):799-804.
[14] Yadav M,Grewal MS,Grewal S,et al.Comparison of preoperative oral ketorolac on anesthetic efficacy of inferior alveolar nerve block and buccal and lingual infiltration with articaine and lidocaine in patients with irreversible pulpitis:a prospective,randomized,controlled,double-blind Study.J Endod,2015,41(11):1773-1777.
[15] Ong KS,Seymour RA,Chen FG,et al.Preoperative ketorolac has a preemptive effect for postoperative third molar surgical pain.Int J Oral Maxillofac Surg,2004,33(8):771-776.
[16] Kim SK,Hong JP,Nam SM,et al.Analgesic effect of preoperative topical nonsteroidal antiinflammatory drugs on postoperative pain after laser-assisted subepithelial keratectomy.J Cataract Refract Surg,2015,41(4):749-755.
[17] Stanski DR,Cherry C,Bradley R,et al.Efficacy and safety of single doses of intramuscular ketorolac tromethamine compared with meperidine for postoperative pain.Pharmacotherapy,1990,10(6):40S-44S.
[18] O'hara DA,Fragen RJ,Kinzer M,et al.Ketorolac tromethamine as compared with morphine sulfate for treatment of postoperative pain.Clin Pharmacol Ther,1987,41(5):556-561.
[19] Picard P,Bazin JE,Conio N,et al.Ketorolac potentiates morphine in postoperative patient-controlled analgesia.Pain,1997,73(3):401-406.
[20] Power I,Bowler GM,Pugh GC,et al.Ketorolac as a component of balanced analgesia after thoracotomy.Br J Anaesth,1994,72(2):224-226.
[21] Singh H,Bossard RF,White PF,et al.Effects of ketorolac versus bupivacaine coadministration during patient-controlled hydromorphone epidural analgesia after thoracotomy procedures.Anesth Analg,1997,84(3):564-569.
[22] Axelsson K,Gupta A,Johanzon E,et al.Intraarticular administration of ketorolac,morphine,and ropivacaine combined with intraarticular patient-controlled regional analgesia for pain relief after shoulder surgery:a randomized,double-blind study.Anesth Analg,2008,106(1):328-333.
[23] Kim TW,Park SJ,Lim SH,et al.Which analgesic mixture is appropriate for periarticular injection after total knee arthroplasty?Prospective,randomized,double-blind study.Knee Surg Sports Traumatol Arthrosc,2015,23(3):838-845.
[24] Cassinelli EH,Dean CL,Garcia RM,et al.Ketorolac use for postoperative pain management following lumbar decompression surgery:a prospective,randomized,double-blinded,placebo-controlled trial.Spine,2008,33(12):1313-1317.
[25] Lowder JL,Shackelford DP,Holbert D,et al.A randomized,controlled trial to compare ketorolac tromethamine versus placebo after cesarean section to reduce pain and narcotic usage.Am J Obstet Gynecol,2003,189(6):1559-1562.
[26] Russo A,Di Stasio E,Bevilacqua F,et al.Efficacy of scheduled time ketorolac administration compared to continuous infusion for post-operative pain after abdominal surgery.Eur Rev Med Pharmacol Sci,2012,16(12):1675-1679.
[27] Mesen TB,Kacemi-Bourhim L,Marshburn PB,et al.The effect of ketorolac on pregnancy rates when used immediately after oocyte retrieval.Fertil Steril,2013,100(3):725-728.
[28] 章壮云,胡建,刘耿,等.地佐辛复合酮咯酸氨丁三醇术后PCIA的效果及对血清五羟色胺和P物质的影响.临床麻醉学杂志,2013,29(9):863-866.
[29] R?msing J,Ostergaard D,Walther-Larsen S,et al.Analgesic efficacy and safety of preoperative versus postoperative ketorolac in paediatric tonsillectomy.Acta Anaesthesiol Scand,1998,42(7):770-775.
[30] Jo YY,Hong JY,Choi EK,et al.Ketorolac or fentanyl continuous infusion for post-operative analgesia in children undergoing ureteroneocystostomy.Acta Anaesthesiol Scand,2011,55(1):54-59.
[31] Stricker PA,Muhly WT,Jantzen EC,et al.Intramuscular fentanyl and ketorolac associated with superior pain control after pediatric bilateral myringotomy and tube placement surgery:a retrospective cohort study.Anesth Analg,2017,124(1):245-253.
[32] Sucato DJ,Lovejoy JF,Agrawal S,et al.Postoperative ketorolac does not predispose to pseudoarthrosis following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis.Spine,2008,33(10):1119-1124.
[33] Inoue M,Caldarone CA,Frndova H,et al.Safety and efficacy of ketorolac in children after cardiac surgery.Intensive Care Med,2009,35(9):1584-1592.
[34] Gupta A,Daggett C,Drant S,et al.Prospective randomized trial of ketorolac after congenital heart surgery.J Cardiothorac Vasc Anesth,2004,18(4):454-457.
[35] Cepeda MS,Carr DB,Miranda N,et al.Comparison of morphine,ketorolac,and their combination for postoperative pain:results from a large,randomized,double-blind trial.Anesthesiology,2005,103(6):1225-1232.
[36] Zackova M,Taddei S,Calò P,et al.Ketorolac vs tramadol in the treatment of postoperative pain during maxillofacial surgery.Minerva Anestesiol,2001,67(9):641-646.
[37] Bakr MA,Amr SA,Mohamed SA,et al.Comparison between the effects of intravenous morphine,tramadol and ketorolac on stress and immune responses in patients undergoing modified radical mastectomy.Clin J Pain,2016,32(10):889-897.
[38] Lepri A,Sia S,Catinelli S,et al.Patient-controlled analgesia with tramadol versus tramadol plus ketorolac.Minerva Anestesiol,2006,72(1-2):59-67.
[39] Kim SY,Kim EM,Nam KH,et al.Postoperative intravenous patient-controlled analgesia in thyroid surgery:comparison of fentanyl and ondansetron regimens with and without the nonsteriodal anti-inflammatory drug ketorolac.Thyroid,2008,18(12):1285-1290.
[40] Olsen JC,Mcgrath NA,Schwarz DG,et al.A double-blind randomized clinical trial evaluating the analgesic efficacy of ketorolac versus butorphanol for patients with suspected biliary colic in the emergency department.Acad Emerg Med,2008,15(8):718-722.
[41] Hosseininejad SM,Amini Ahidashti H,Bozorgi F,et al.Efficacy and safety of combination therapy with ketorolac and morphine in patient with acute renal colic;a triple-blind randomized controlled clinical trial.Bull Emerg Trauma,2017,5(3):165-170.
[42] Motov S,Yasavolian M,Likourezos A,et al.Comparison of intravenous ketorolac at three single-dose regimens for treating acute pain in the emergency department:a randomized controlled trial.Ann Emerg Med,2017,70(2):177-184.
[43] Ortiz MI,Monroy-Maya R,Soto-Ríos M,et al.Effectiveness of diclofenac,ketorolac and etoricoxib in the treatment of acute pain from ankle fracture.Proc West Pharmacol Soc,2010,53:46-48.
[44] NCCN clinical practice guidelines in oncology-adult cancer pain(2018 Version 1).https://www.nccn.org.
[45] Staquet MJ.A double-blind study with placebo control of intramuscular ketorolac tromethamine in the treatment of cancer pain.J Clin Pharmacol,1989,29(11):1031-1036.
[46] Carlson RW,Borrison RA,Sher HB,et al.A multiinstitutional evaluation of the analgesic efficacy and safety of ketorolac tromethamine,acetaminophen plus codeine,and placebo in cancer pain.Pharmacotherapy,1990,10(3):211-216.
[47] Hughes A,Wilcock A,Corcoran R.Ketorolac:continuous subcutaneous infusion for cancer pain.J Pain Symptom Manage,1997,13(6):315-316.
[48] Mercadante S,Fulfaro F,Casuccio A.A randomised controlled study on the use of anti-inflammatory drugs in patients with cancer pain on morphine therapy:effects on dose-escalation and a pharmacoeconomic analysis.Eur J Cancer,2002,38(10):1358-1363.
[49] 王爱桃,姚尚龙,杜晓冰,等.酮咯酸氨丁三醇预防性镇痛对乳腺癌改良根治术患者镇痛效果及免疫功能的影响.临床麻醉学杂志,2016,32(11):1084-1086.
[50] Carvalho B,Lemmens HJ,Ting V,et al.Postoperative subcutaneous instillation of low-dose ketorolac but not hydromorphone reduces wound exudate concentrations of interleukin-6 and interleukin-10 and improves analgesia following cesarean delivery.J Pain,2013,14(1):48-56.
[51] Carney DE,Nicolette LA,Ratner MH,et al.Ketorolac reduces postoperative narcotic requirements.J Pediatric Surg,2001,36(1):76-79.
[52] 国家风湿数据中心,中国系统性红斑狼疮研究协作组.非甾体消炎药相关消化道溃疡与溃疡并发症的预防与治疗规范建议.中华内科杂志,2017,56(1):81-85.
[53] Harris SI,Kuss M,Hubbard RC,et al.Upper gastrointestinal safety evaluation of parecoxib sodium,a new parenteral cyclooxygenase-2-specific inhibitor,compared with ketorolac,naproxen,and placebo.Clin Ther,2001,23(9):1422-1428.
[54] Strom BL,Berlin JA,Kinman JL,et al.Parenteral ketorolac and risk of gastrointestinal and operative site bleeding.A postmarketing surveillance study.JAMA,1996,275(5):376-382.
[55] Flint J,Panchal S,Hurrell A,et al.BSR and BHPR guideline on prescribing drugs in pregnancy and breastfeeding-Part II:analgesics and other drugs used in rheumatology practice.Rheumatology,2016,55(9):1698-1702.
[56] Nielsen GL,S?rensen HT,Larsen H,et al.Risk of adverse birth outcome and miscarriage in pregnant users of non-steroidal anti-inflammatory drugs:population based observational study and case-control study.BMJ,2001,322(7281):266-270.
[57] K?llén BA,Otterblad Olausson P.Maternal drug use in early pregnancy and infant cardiovascular defect.Reprod Toxicol,2003,17(3):255-261.
[58] Bloor M,Paech M.Nonsteroidal anti-inflammatory drugs during pregnancy and the initiation of lactation.Anesth Analg,2013,116(5):1063-1075.
[59] Wischnik A,Manth SM,Lloyd J,et al.The excretion of ketorolac tromethamine into breast milk after multiple oral dosing.Eur J Clin Pharmacol,1989,36(5):521-524.