Postoperative pain
Pain following surgical intervention. NSAIDs reduce opioid analgesic requirements. Ketorolac is one of the most effective parenteral NSAIDs for this purpose.
ICD-10 R52.03 drugs
Also known as: Post-surgical pain
Drugs used for this condition
- AKetorolacFirst line · Non-steroidal anti-inflammatory drugs (NSAIDs)Widely used in the early postoperative period. Reduces opioid requirements by 25–45%. Intramuscularly or intravenously – 30 mg loading dose, then 15–30 mg every 6 hours. In patients over 65, weighing under 50 kg, or with renal impairment – maximum 60 mg daily. Total parenteral and oral course duration must not exceed 5 days.
- BMeperidineSecond line · Opioid analgesic, phenylpiperidine classMeperidine is used for acute postoperative pain and renal colic when morphine is contraindicated. In Spain Dolantina is historically used in obstetrics and perioperative care. SED has since 2020 recommended restricting use due to normeperidine neurotoxicity on repeated doses and high risk of fatal serotonin syndrome with MAO inhibitors and SSRIs.
- CLidocaineAdd-on therapy · Amide-type local anaesthetic and class Ib antiarrhythmic (systemic use, codes C01BB01 and N01BB02)A continuous intravenous lidocaine infusion during and after surgery belongs to multimodal analgesia regimens: the expectation is a lower opioid requirement and earlier return of bowel function. The 2018 Cochrane review pooled 68 trials and nearly 4500 participants and rated the evidence as low and very low quality: the difference in pain at 1–4 hours after surgery is small and clinically questionable, the effect is lost by 24 hours, and data on bowel recovery are heterogeneous. Adverse events were recorded sparsely in the trials, and the authors could not judge safety from them. The practical conclusion: it works as an adjunct in a well-monitored theatre where concentration and rhythm are watched, but it does not replace opioid or regional analgesia.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit