SummaryPostoperative pain is a serious problem, requiring an appropriate response from the medical doctor. In otolaryngology special attention is needed after uvulopala topharyngoplasty (UP3). Aim: To compare the efficacy of postoperative analgesia using ketorolac and ketoprofen after UP3. Patients and Methods: A prospective, randomized, double-blind study was made of 24 patients that were divided into 2 groups (14 received ketorolac and 10 received ketoprofen). Pain intensity was based on an analog visual scale and the need for opioids (tramadol). Results: Of the 13 patients that received ketorolac, 3 (21%) required opioids; 7 of 10 (70%) patients in ketoprofen group used opioids. 12 hours after surgery, 71% of the patients that received ketorolac had mild or absence of pain. 70% of the ketoprofen users reported moderate to significant pain. 24 hours after surgery, 60% of the patients using ketoprofen reported moderate to significant pain, while 86% of the ketorolac users reported mild or absence of pain. Conclusion: We concluded that ketorolac is more effective compared to ketoprofen in the treatment of immediate postoperative pain after UP3, as patients using ketorolac had less pain and used opioids to a lesser degree

de Oliveira Rangel, Marcelo

Miziara, Gustavo Sousa Marques

Patrocinio, Tomas Gomes

Patrocínio, José Antonio

Patrocínio, Lucas Gomes

Rodrigues, Alexandre Menezes

Brazilian Journal of Otorhinolaryngology

Elsevier - Publisher Connector 

A comparative study between Ketorolac and Ketoprofen in postoperative pain after uvulop alatopharyngoplasty 

339
BRAZILIAN JOURNAL OF OTORHINOLARYNGOLOGY 73 (3) MAY/JUNE 2007
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A comparative study between 
Ketorolac and Ketoprofen in 
postoperative pain after uvulop
alatopharyngoplasty
   Summary
Lucas Gomes Patrocínio 1, Marcelo de Oliveira 
Rangel 2, Gustavo Sousa Marques Miziara 3, 
Alexandre Menezes Rodrigues 4, José Antonio 
Patrocínio 5, Tomas Gomes Patrocinio 6
1 Physician, Resident in the Otorhinolaryngology Unit of the Uberlandia Federal University Medical School.
2 Physician, Resident in the Otorhinolaryngology Unit of the Uberlandia Federal University Medical School.
3 Physician, Resident in the Otorhinolaryngology Unit of the Uberlandia Federal University Medical School.
4 Doctor on Anesthesiology, Anesthetist of the Anesthesiology Unit of the Santa Genoveva Hospital.
5 Full Professor, Head of the Otorhinolaryngology Unit of the Uberlandia Federal University Medical School.
6 Physician, Resident in the Otorhinolaryngology Unit of the Uberlandia Federal University Medical School.
Otorhinolaryngology Unit of the Santa Genoveva Hospital, Uberlandia, Minas Gerais, Brazil.
Address for correspondence: Lucas Gomes Patrocinio - Rua XV de Novembro 327 ap. 1600 Bairro Centro Uberlandia MG 38400-214.
Tel/Fax: (0xx34) 3215-1143 - E-mail: lucaspatrocinio@triang.com.br
Paper submitted to the ABORL-CCF SGP (Management Publications System) on April 25th, 2006 and accepted for publication on August 2nd, 2006. cod. 1864.
Postoperative pain is a serious problem, requiring 
an appropriate response from the medical doctor. In 
otolaryngology special attention is needed after uvulopala
topharyngoplasty (UP3). Aim: To compare the efficacy of 
postoperative analgesia using ketorolac and ketoprofen after 
UP3. Patients and Methods: A prospective, randomized, 
double-blind study was made of 24 patients that were 
divided into 2 groups (14 received ketorolac and 10 received 
ketoprofen). Pain intensity was based on an analog visual 
scale and the need for opioids (tramadol). Results: Of the 
13 patients that received ketorolac, 3 (21%) required opioids; 
7 of 10 (70%) patients in ketoprofen group used opioids. 12 
hours after surgery, 71% of the patients that received ketorolac 
had mild or absence of pain. 70% of the ketoprofen users 
reported moderate to significant pain. 24 hours after surgery, 
60% of the patients using ketoprofen reported moderate to 
significant pain, while 86% of the ketorolac users reported 
mild or absence of pain. Conclusion: We concluded that 
ketorolac is more effective compared to ketoprofen in the 
treatment of immediate postoperative pain after UP3, as 
patients using ketorolac had less pain and used opioids to 
a lesser degree. 
Keywords: sleep apnea, postoperative, pain, obtructive, 
snoring.
ORIGINAL ARTICLE
Rev Bras Otorrinolaringol
2007;73(3):339-42.
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BRAZILIAN JOURNAL OF OTORHINOLARYNGOLOGY 73 (3) MAY/JUNE 2007
http://www.rborl.org.br  /  e-mail: revista@aborlccf.org.br
INTRODUCTION
Pain is defined as an unpleasant sensory and emo-
tional experience resulting from, or described in terms of, 
true or potential tissue injury. Pain sets in motion mecha-
nisms in the body that result in incapacity and adverse 
biopsychosocial effects.1
The intensity and expression of pain vary conside-
rably between subjects and between animal species. It is 
also affected by environmental, racial, religious, cultural, 
and philosophical factors, and by past experience and the 
mental state.1,2
Measurement of pain is essential for its treatment. 
Being a subjective experience, pain cannot be measured 
objectively by physical instruments such as those that 
measure weight, temperature, and blood pressure. On the 
other hand a variety of tools for assessing subjectivity are 
available that allow patients to measure the intensity of 
pain with little mental or physical effort. Various scales are 
available: the Verbal Rating Scale, the Pain Relief Ordinal 
Scale, the Numeric Rating Scale, the Visual Analog Scale, 
and the Faces Pain Scale. Any pain assessment process 
should be systematic and continuous, and should be 
reported so that there is an effective contribution to the 
treatment of pain.3
Immediate postoperative pain (during the first 24 
hours) is a difficult daily problem that requires adequate 
support from physicians. Special attention is required for 
the treatment of pain in otorhinolaryngology following 
tonsillectomy and uvulopalatopharyngoplasty (UPPP). 
UPPP is a procedure done by otorhinolaryngologists as an 
option to treat the obstructive sleep apnea and hypopnea 
syndrome (OSAHS). Regardless of the technique, pain after 
these procedures is classified as moderate to severe.
Various analgesic drugs have been used against 
postoperative pain following UPPP. Ketorolac tromethami-
ne (Toradol ) is a non-steroidal anti-inflammatory drug 
(NSAID) that has an analgesic efficacy similar to commonly 
used opioids, and that recently has found wide acceptan-
ce in the treatment of postoperative pain in a variety of 
surgical procedures. Ketorolac is used for moderate pain 
relief; it may be used to treat severe pain when associated 
with opioids, reducing the opioid dose. The advantage 
of this association is the reduction of opioid side effects 
such as respiratory depression, pruritus, urinary retention, 
sedation and nausea.4-6
The aim of this paper was to measure the analgesic 
effect of ketorolac during the immediate postoperative 
period following UFPF. This drug was compared with 
ketoprofen, another well-known anti-inflammatory drug 
that is also used parenterally, to assess the analgesic effect 
and the need for opioids.
PATIENTS AND METHOD
This trial was a prospective, randomized, blinded 
study that included 24 patients aged between 21 and 60 
years that underwent UPPP between June 2004 and June 
2005.
A single intervention associated septoplasty, partial 
inferior turbinectomy, and tonsillectomy in all of the cases. 
Patients with a history of allergic reactions to NSAIDs, as-
thma, gastroduodenal ulcers, or bleeding disorders were 
excluded. Also excluded were patients in which other 
procedures such as glossectomy, blepharoplasty, ritido-
plasty, or sinusectomy were added.
The intensity of postoperative pain was assessed in 
these patients 12 and 24 hours after the surgical procedure. 
Assessment of pain intensity was based on the faces pain 
scale and a 6-point verbal rating scale.
The trial was a comparative study of the analgesic 
effect of ketorolac tromethamine (30 mg EV every 8 hours, 
beginning at induction of anesthesia) and ketoprofen (100 
mg EV, every 12 hours), and the need for rescue medica-
tion with an opioid (tramadol).
The analgesic drug for each patients was chosen 
randomly based on the last digit of their medical chart 
number (if odd - Ketorolac; if even - Ketoprofen).
Before surgery, the medical team handed a form 
over to the patient and family member containing their 
name, age, chart number, type of surgical procedure, 
analgesic medication used, and the visual pain scale; ins-
tructions on how to fill in the form correctly was given at 
this time. Furthermore, patients were told that if excessive 
pain was felt, they should call the nurse; the nurse would 
inform the medical team and administer tramadol.
UPPP was done under general anesthesia to which 
was added local infiltration of bupivacaine 0.5% with adre-
nalin 1:80.000 on the base of the uvula and the palatine 
arch. Oblique bilateral incisions were made on the superior 
portion of the tonsillar pillars, followed by partial sectio-
ning with electrocautery of the uvula. Vicryl 3.0 sutures 
were made on the posterior and anterior pillars.
Results were assessed statistically using the chi-
squared and Student’s t-test. The trial was approved by 
the Research Ethics Committee of the institution and given 
the number 025/04.
RESULTS
UPPP was done on 24 patients, of which 14 received 
ketorolac and 10 received ketoprofen. The groups were 
compared according to gender and number of patients. 
There was no significant difference between the number 
of patients in each group, but males predominated in both 
groups (Table 1).
Twenty one percent of 14 patients that received 
ketorolac used opioids postoperatively. Seventy percent 
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of 10 patients that received ketoprofen used opioids for 
the treatment of postoperative pain following UPPP (p < 
0.01) (Table 2).
The visual analog scale and the verbal rating scale 
revealed significant differences in the analysis of pain 
intensity 12 and 24 hours after surgery. Twelve hours 
postoperatively, mild or absent pain was present in 71% 
of patients that were medicated with ketorolac, and mode-
rate or annoying pain was present in 70% of patients that 
were medicated with ketoprofen (Table 3 and Chart 1) (p 
< 0.05). Twenty-four hours postoperatively, moderate or 
annoying pain was reported by 60% of patients that were 
Table 1. Distribution of patients undergoing uvulopalatopharyngo-
plasty according to gender and medication.
Drug used Male Female Total
Ketoprofen 9 (90%) 1 (10%) 10
Ketorolac 11 (79%) 3 (21%) 14
Total 20 (83%) 4 (17%) 24
p < 0,05
Table 2. Distribution of patients undergoing uvulopalatopharyngo-
plasty according to the need for postoperative rescue medication 
(tramadol).
Drug used
Use of trama-
dol
Non-use of 
tramadol
Total
Ketoprofen 7 (70%) 3 (30%) 10
Ketorolac 4 (21%) 10 (79%) 14
Total 11 (46%) 13 (54%) 24
p < 0,05
Table 3. Distribution of patients undergoing uvulopalatopharyngoplasty according to the intensity of pain 12 hours postoperatively.
Drug
Absence of 
pain
Mild pain Moderate pain Annoying pain Severe pain
Unbearable 
pain
Total
Ketoprofen 0 3 (30%) 4 (40%) 3 (30%) 0 0 10
Ketorolac 6 (43%) 4 (29%) 1 (7%) 3 (21%) 0 0 14
Total 6 7 5 6 0 0 24
p < 0,05
Table 4. Distribution of patients undergoing uvulopalatopharyngoplasty according to the intensity of pain 24 hours postoperatively.
Drug
Absence of 
pain
Mild pain Moderate pain Annoying pain Severe pain
Unbearable 
pain
Total
Ketoprofen 1 (10%) 3 (30%) 3 (30%) 2 (20%) 1 (10%) 0 10
Ketorolac 6 (43%) 6 (43%) 1 (7%) 1 (7%) 0 0 14
Total 7 9 4 3 1 0 24
p < 0,05
Chart 1. Distribution of patients undergoing uvulopalatopharyngoplasty 
according to the intensity of pain 12 hours postoperatively.
Chart 2. Distribution of patients undergoing uvulopalatopharyngoplasty 
according to the intensity of pain 24 hours postoperatively.
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BRAZILIAN JOURNAL OF OTORHINOLARYNGOLOGY 73 (3) MAY/JUNE 2007
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medicated with ketoprofen, and 86% of patients that were 
medicated with ketorolac reported mild or absent pain 
(Table 4 and Chart 2) (p < 0.05).
There were no perioperative or postoperative 
complications.
DISCUSSION
Current treatment of pain is based on the concept 
of balanced or multimodal analgesia in which pharmaco-
logically different drugs are used to obtain synergy and a 
lower rate of undesired effects.7 Careful management of 
postoperative analgesia results in a reduced hospital stay, 
earlier recovery of function (especially food intake), and 
increased success of the surgery in general.8 In our trial 
the use of opioids was significantly lower in the group 
that received ketorolac compared to ketoprofen (p < 0.05). 
Furthermore, reported subjective pain was significantly 
lower at 12 and 24 hours after surgery (p < 0.05).
The efficacy of ketorolac has already been de-
monstrated in other trials investigating pain relief after 
tonsillectomy. Rusy et al. (1995) found that ketorolac was 
more effective than acetaminophen in the treatment of 
postoperative pain following tonsillectomy in children.9 
Forrest et al. (1997) reported that ketorolac was more ad-
vantageous compared to opioid analgesics in the control 
of post-tonsillectomy pain. This was due to lower rates 
of sedation, nausea, vomiting, and respiratory depression 
and a similar level of analgesia when using ketorolac, 
compared to commonly used opioids.10
Tarkkila and Saarnivaara (1999)11 compared ketoro-
lac, ketoprofen, and diclofenac postoperatively following 
elective tonsillectomy, and reported a lower use of opioids, 
improved pain control, and a similar complication rate 
compared to placebo. These findings are similar to those 
we found in our trial. Until now no papers had been pu-
blished evaluating ketorolac after UPPP.
O’Donovan et al.12 (1994) and Pernice et al.13 (2001) 
demonstrated that ketorolac is also effective in controlling 
postoperative pain and reducing urinary retention follo-
wing hemorrhoidectomy. According to Carney et al. 
(2001)5 ketorolac reduced the use of opioids and lowe-
red the morbidity during the first 48 hours after pediatric 
surgery. Furthermore, patients receiving ketorolac did not 
present increased bleeding or kidney toxicity compared 
to the group that received morphine only. Shende and 
Das (1999)14 reported a lower rate of vomiting and pain 
when using ketorolac postoperatively after strabismus 
surgery in children compared to the placebo group. The 
rate of postoperative bleeding was similar to that found 
in traditional treatments.
Many papers have shown that ketorolac used in 
subjects below 65 years, at an average dose of 100 mg/day 
or less, during 5 days or less, was not associated with a 
detectable increased risk of gastrointestinal or surgical 
wound bleeding. 4 We also found that postoperative ble-
eding was not increased in our sample.
CONCLUSION
We concluded that ketorolac is more effective 
compared to ketoprofen to treat immediate postoperative 
pain following UPPP. Patients medicated with ketorolac 
had pain of lower intensity compared to those treated with 
ketoprofen, and required less opioids as supplementary 
treatment.
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A comparative study between Ketorolac and Ketoprofen in postoperative pain after uvulop alatopharyngoplasty

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