Non-narcotic pain medication is safe and effective after sinus surgery

MAYWOOD, Il. -- Patients who have undergone sinus surgery can safely take an alternative pain medication that does not cause the side effects of narcotics such as fentanyl and Vicodin, a Loyola University Health System study has found.

The alternative medication is ketorolac (brand name, Toradol). It is in the same class of nonsteroidal anti-inflammatory drugs as Advil and Aleve. Ketorolac does not cause the side effects that narcotic drugs cause, such as itching, nausea, vomiting, constipation and drowsiness, said Kevin Welch, MD, corresponding author of the study, published online ahead of print in the International Forum of Allergy and Rhinology.

Earlier studies have found that ketorolac is a safe and effective pain medication following cardiothoracic and other surgeries. Conversely, several studies have found that ketorolac increases postoperative bleeding in children who have had tonsillectomies. Consequently, ear-nose-throat surgeons have shied away from prescribing ketorolac for sinus surgery patients. About 500,000 sinus surgeries, mostly outpatient, are performed each year in the United States.

The ketorolac studies on tonsillectomy patients have been disputed by experts who note methodological flaws. These experts also question how ketorolac could have been the cause of the bleeding reported in the tonsillectomy studies, since the effects of the short-acting drug wore off hours before the bleeding occurred.

Welch and colleagues conducted the first study of its kind to evaluate whether ketorolac caused bleeding in sinus surgery patients. The study was randomized and double-blind.

Patients received intravenous ketorolac or intravenous fentanyl shortly after reaching the recovery room following endoscopic sinus surgery. Nasal bleeding was assessed on the first and seventh days after surgery. There were no significant differences between the ketorolac group and fentanyl group in any of the four measures used to assess nasal bleeding. Nor was there a significant difference in anemia due to blood loss. There also were no significant differences between the two groups in pain upon entering the recovery room or at 30 minutes or 60 minutes after receiving either drug.

Ketorolac is available in pill form. "Our study suggests the need for further research to determine whether ketorolac could replace narcotic medications for pain relief after patients go home," Welch said.

Welch is an assistant professor in the Department of Otolaryngology of Loyola University Chicago Stritch School of Medicine. Co-authors, all at Loyola, are Carl Moeller, MD (first author), Julius Pawlowski, MD, Ana L. Pappas, MD and Keith Fargo, PhD.