Ketorolac Tromethamine, a Nonsteroidal Anti-inflammatory Drug: Ability to Inhibit Post-radical Pelvic Surgery Adhesions in a Porcine Model

The objective of this study was to investigate the ability of ketorolac tromethamine, a parenterally administered nonsteroidal anti-inflammatory drug (NSAID), to inhibit post-radical pelvic surgery adhesion formation (PRPSA). Twenty adult female hogs undergoing radical hysterectomy, bilateral salpingo-oophorectomy, and resection of pelvic peritoneum were used. Animals were randomized to either ketorolac (4 mg/kg loading dose 45 min prior to skin incision, followed by 2 mg/kg IM every 8 hr for nine doses) or no adjuvant therapy. Four weeks after surgery, repeat celiotomy was performed, and adhesions were quantified. Note was made of any bowel segments adherent to the pelvis. Adhesion scores for the ketorolac-treated animals (n = 9, mean = 0.92 +/- 0.54, median = 0.90) were significantly less than those for control animals (n = 10, mean = 6.73 +/- 2.21, median = 7.03, P = 0.0001). Similarly, significantly fewer treated animals had small bowel loops adherent in the pelvis when compared to control animals (11% vs 90%, P = 0.001). Ketorolac is an effective inhibitor of PRPSA formation and limits small bowel adherence to the pelvis.