GP1b - Does a Single Preoperative Dose of Ketorolac Decrease Postoperative Pain Following Dentoalveolar Surgery?

Abstract: Statement of the Problem: Postoperative pain after dentoalveolar surgery remains a common clinical concern. Preemptive analgesia has been shown to decrease postoperative pain and opioid-related complications.¹ Ketorolac is a non-steroidal anti-inflammatory drug used for pain control. Although prior studies have shown analgesic benefit with ketorolac in third molar surgery, information regarding its effect in broader dentoalveolar surgery populations remains limited.² This study investigated whether a single preoperative dose of ketorolac decreases postoperative pain in patients undergoing dentoalveolar surgery.

Materials and Methods Used in the Investigation of the Problem: The investigators implemented a retrospective cohort study of consecutive subjects who underwent dentoalveolar surgery under deep intravenous sedation in the outpatient oral and maxillofacial surgery clinic at the University of Rochester Medical Center between July 2023 and March 2025. Inclusion criteria were age 15 years or older, 1 or more tooth extractions, outpatient treatment, and deep intravenous sedation. Exclusion criteria were procedures other than tooth extractions, treatment under local anesthesia or in the operating room, vulnerable population status, current drug abuse, chronic pain, or incomplete medical records. Subjects were stratified into 2 groups: conventional and treatment, with the latter receiving a single preoperative dose of intravenous ketorolac. The sample size was 194 subjects.

Method of Data Analysis: Data were analyzed using SAS statistical software version 9.4. Study duration was 21 months. Categorical variables were summarized as percentages, and continuous variables as means ± standard deviation. Pearson χ2 test or Fisher exact test was used for categorical variables. Two-sample t-test and 1-way analysis of variance were used for continuous variables, as appropriate. Postoperative mean arterial pressure (MAP) in millimeters of mercury and heart rate (HR) in beats per minute at 30 minutes were used as surrogate measures of pain. Statistical significance was set at P ≤ .05.

Results of Investigation and Outcomes Data: Of 2,269 screened subjects, 194 met the inclusion criteria. The conventional group included 117 subjects (60%), and the treatment group included 77 subjects (40%). Subjects in the treatment group were younger (25 ± 7.4 years vs 29 ± 13.1 years, P = .008), were more frequently American Society of Anesthesiologists class (ASA) II (65 [84.4%] vs 81 [69.2%], P = .003), and less often received postoperative ketorolac (2 [3%] vs 15 [13%], P = .02). There was no statistically significant difference in postoperative MAP at 30 minutes between groups (high MAP: 26 [33.8%] vs 40 [34.2%], P = .95). Subjects in the conventional group were more frequently in the low HR group at 30 minutes than subjects in the treatment group (74 [63.2%] vs 36 [46.8%], P = .02). Across the cohort, postoperative MAP at 30 minutes was significantly higher in smokers (91.76 ± 11.39, P = .03). Postoperative HR at 30 minutes was significantly higher in females (82.3 ± 15, P = .003), ASA class III subjects (79.2 ± 12, P = .04), and tetrahydrocannabinol users (77.2 ± 16, P = .05).

Conclusions Relevant to the Problem: A single preoperative dose of ketorolac was not associated with decreased postoperative pain when MAP and HR were used as surrogate measures of pain after dentoalveolar surgery. However, the lower need for postoperative ketorolac in the treatment group suggests a possible early analgesic benefit. Future studies should use validated patient-reported pain measures.


References:

1. Pozos-Guillen A, Martinez-Rider R, Aguirre-Banuelos P, Perez-Urizar J. Pre-emptive analgesic effect of tramadol after mandibular third molar extraction: a pilot study. J Oral Maxillofac Surg 2007;65(7):1315-20.

2. Ong KS, Seymour RA, Chen FG, Ho VC. Preoperative ketorolac has a preemptive effect for postoperative third molar surgical pain. Int J Oral Maxillofac Surg 2004;33(8):771-6.