***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Purpose . A comparison of a previously reported indirect ( precolumn derivatization ) assay for ketorolac ( KT ) and a new direct method described here was made to establish the conditions under which KT may undergo racemization and to explain the observed discrepancies in the pharmacokinetics of KT reported in the literature . Methods . A previously reported pre-column derivatization method and a new direct method were employed to determine the effect of  pH and ionic strength on racemization . Using the conditions where no racemization occurred , the pharmacokinetics in humans and rats , and protein binding of KT enantiomers were determined . Results . Under the chromatographic conditions employed for the direct assay , no racemization was observed . Under high pH and ionic strength , however , both methods result ed in KT racemization . The indirect method result ed in rapid and complete racemization due to the strong basic conditions required for derivatization . In both humans and rats , the pharmacokinetics of racemic KT were stereoselective with the R enantiomer being predominant ( AUC S/R : humans , 0.26 ; Rats : 0.45 ) . This is likely due to more extensive plasma protein binding of S than its antipode ( unbound S/R : 1.35 ) . Conclusions . The discrepancies in the literature may be explained by rapid racemization of KT that occurs during sample preparation for the pre-column derivatization method . Considerations should be given to the possibility of racemization during the assay development and validation We studied intensity of pain , cumulative morphine consumption , ventilatory and renal function , and haemostasis in patients undergoing video-assisted thoracoscopic surgery and receiving a 2-day i.v . infusion of diclofenac , ketorolac or saline .  Plasma concentrations of the two NSAID were also measured . The study was r and omized , double-blind and placebo-controlled , with 10 patients in each group . Patients experienced mainly moderate pain . Mean consumption of i.v . morphine during the first day after operation was 57 ( SEM 11 ) mg in the placebo group . Diclofenac and ketorolac were equally effective in reducing total morphine consumption ( 61 % and 52 % , respectively ) . Adverse events were similar and minor . Greater variability in plasma concentrations of ketorolac were detected compared with diclofenac Postoperative pain can have a significant effect on patient recovery . An underst and ing of patient attitudes and concerns about postoperative pain is important for identifying ways health care professionals can improve postoperative care . To assess patients ’ postoperative pain experience and the status of acute pain management , we conducted a national study by using telephone question naires . A r and om sample of 250 adults who had undergone surgical procedures recently in the United States was obtained from National Family Opinion . Patients were asked about the  severity of postsurgical pain , treatment , satisfaction with pain medication , patient education , and perceptions about postoperative pain and pain medications .  Approximately 80 % of patients experienced acute pain after surgery . Of these patients , 86 % had moderate , severe , or extreme pain , with more patients experiencing pain after discharge than before discharge . Experiencing postoperative pain was the most common concern ( 59 % ) of patients . Almost 25 % of patients who received pain medications experienced adverse effects ; however , almost 90 % of them were satisfied with their pain medications . Approximately two thirds of patients reported that a health care professional talked with them about their pain . Despite an increased focus on pain management programs and the development of new st and ards for pain management , many patients continue to experience intense pain after surgery . Additional efforts are required to improve patients ’ postoperative pain experience BACKGROUND AND PURPOSE To decrease postoperative dependence on narcotics for analgesia , we have evaluated ketorolac as an adjunct to perioperative pain control in patients undergoing laparoscopic urologic surgery . PATIENTS AND METHODS Sixty-five patients ( 34 male , 31 female ) were r and omized to receive either  ketorolac tromethamine ( 15 - 30 mg IV q 6 h ) or placebo  prior to laparoscopic surgery .  Patient-controlled analgesia in the form of morphine sulfate was provided . Operative factors such as the type of surgery , operative time , and estimated blood loss were recorded . Postoperative factors such as analog pain score ( range 0 - 10 ) , narcotic usage , and length of stay were evaluated . RESULTS Fifty-five patients completed the study . The average pain score was 2.2 and 4.5 for the ketorolac and placebo groups , respectively ( P < 0.005 ) . The mean amounts of total morphine used were 39.2 mg ( ketorolac ) and 62.5 mg ( placebo ) ( P = 0.077 ) . The length of stay was not significantly different in the ketorolac ( 2.5 days ) and placebo ( 2.6 days ) groups ( P = 0.74 ) . Operative times ( P = 0.21 ) and estimated blood loss ( P = 0.60 ) were not significantly different in the two groups . Ketorolac did not adversely affect renal function ; serum creatinine changes were not significantly different from those in the patients receiving placebo ( P = 0.50 ) . Laparoscopic pyeloplasty necessitated more narcotic analgesia than did other laparoscopic procedures ( P = 0.05 ) . CONCLUSION Ketorolac decreases the subjective perception of pain after laparoscopic urologic surgery . It is suggested that ketorolac administration decreases the amount of narcotic usage as well . Time to resumption of oral intake and length of hospital stay were not influenced by use of ketorolac Purpose To assess the postoperative analgesic efficacy and morphine-sparing effect of ketorolac in elderly patients . Methods Sixty ASA-physical status I to III men , aged 60–88 yr , undergoing transvesical prostatectomy were studied according to a r and omized , placebo controlled , double-blind study protocol . A st and ard general anaesthetic was administered . Thirty minutes before concluding the surgical procedure either ketorolac 60 mg or an equal volume of saline was administered , i m . Postoperative pain was assessed hourly for six hours using a 100 mm visual analog score ( VAS ) and a patient-controlled analgesia  ( PCA ) device . Results Hourly PCA-dem and s , actual morphine delivered , and patient generated VAS pain scores were unaffected by the treatment modality . On conclusion of the study the total PCA morphine delivered was 11.9 mg ± 1.38 and 10.8 mg ± 1.52 for the saline and ketorolac groups , respectively . Conclusion The intraoperative administration of ketorolac , 60 mg , i m , was not associated with postoperative morphinesparing or improved analgesia in this elderly population .RésuméObjectifEvaluer l’efficacité analgésique postopératoire et l’effet d’épargne du kétorolac sur la morphine chez les patients âgés . MéthodesSoixante patients du sexe masculin ASA I à III âgés de 60 à 88 ans , soumis à une prostatectomie transvésicale ont fait l’objet d’une étude aléatoire , contrôlée avec placebo et en double aveugle . Une anesthésie générale st and ardisée a été administrée . Trente minutes avant la fin de l’intervention , du kétorolac 60 mg ou une volume égal de soluté physiologique ont été administré i.m . La douleur postopératoire a été évaluée à toutes les heures pour six heures sur une échelle visuelle analogique de 100 mm ( EVA ) et à l’aide d’un dispositif d’analgésie autocontrôlée (PCA).RésultaisLa dem and e horaire sur PCA . la quantité de morphine administrée et le score sur l’EVA fourni par le patient n’ont pas été affectés par le mode de traitement . A la fin de l’étude , la morphine totale administrée était de 11,9 mg ± 1,38 et de 10,8 mg ± 1,52 respectivement pour le groupe soluté physiologique et pour le groupe kétorolac . Conclusion L’administration peropératoire de kélorolac 60 mg i m n’est pas associée à un effet d’épargne sur la morphine ou à une amélioration de l’analgésie chez ces patients âgés We have compared the analgesic and opioid sparing effect of three i.v . non-steroidal anti-inflammatory drugs with placebo in a r and omized , double-blind , placebo-controlled study in 80 adult patients after elective tonsillectomy . A st and ard anaesthetic was used . After induction of anaesthesia , patients received ketoprofen 100 mg , diclofenac 75 mg or ketorolac 30 mg by i.v . infusion over 30 min . Patients in the placebo group received saline . Ketoprofen and diclofenac infusions were repeated after 12 h and ketorolac infusion at 6 h and 12 h. Oxycodone was used as rescue analgesic . Patients in the ketoprofen group requested 32 % less opioid and patients in the diclofenac and ketorolac groups 42 % less opioid than those in the placebo group ( P < 0.05 ) . There were one , two and six patients in the placebo , diclofenac and ketorolac groups , respectively , but none in the ketoprofen group , who did not request opioid analgesia during the study ( P < 0.05 , ketorolac vs placebo and ketoprofen ) . Visual analogue pain scores were similar in all groups . Visual analogue satisfaction scores were significantly higher in the diclofenac group compared with the placebo group . The incidence of nausea was 44 - 54 % . There were no differences in the incidence of other adverse reactions . We conclude that all three non-steroidal anti-inflammatory drugs were superior to placebo after tonsillectomy The analgesia provided in the postoperative period by three regimens commonly used in our private anaesthetic practice were compared in a double-blind study of one hundred and thirty-seven women presenting for day-case laparoscopic procedures . After r and om allocation into three groups , all patients were similarly anaesthetized and then received both a rectal suppository and an IM injection . Group P received two placebos , Group I had an indomethacin suppository 100 mg , and Group K an IM injection of ketorolac 30 mg . The trial showed a statistically significant reduction in pain at 180 minutes postoperatively in the group receiving ketorolac ( visual analog pain score of 13.8 v 21.7 ) . The parenterally administered ketorolac may be a useful analgesic supplement in these patients . However the trial was aborted following the appearance in the literature of case reports of postoperative renal failure . Further investigation of the efficacy and side-effect profile of reduced doses may be warranted One hundred and thirty-seven patients were studied to assess whether the timing of a dose of ketorolac affected cumulative  morphine  requirements during the first 12 post-operative hours . Pain , sedation and nausea scores , respiratory rate and degree of operative blood loss were also recorded . Thirty-six patients ( group A ) were given placebo injections pre- and intra-operatively . Thirty-one patients ( group B ) received placebo pre-operatively and ketorolac 30 mg intra-operatively . Thirty-six patients ( group C ) received ketorolac 10 mg pre-operatively and ketorolac 20 mg intra-operatively and thirty-four patients ( group D ) were given ketorolac 30 mg pre-operatively and placebo intra-operatively . Post-operative analgesia was with intravenous ( i.v . ) morphine administered using a patient controlled analgesia ( PCA ) device . Analysis of variance revealed a significant difference in morphine consumption at 1 , 2 , 4 , 8 and 12 h postoperatively ( P < 0.05 ) between group A ( no ketorolac ) and groups B , C and D ( ketorolac ) . However , there were no significant differences between groups B , C and D during the study period . Thus , the timing of ketorolac administration made no difference to overall morphine consumption . Pain , nausea , sedation and respiratory rate scores were similar in all four groups . There was a significantly greater blood loss in patients receiving ketorolac ( groups B , C and D ) compared with those receiving placebo alone ( group A ) STUDY OBJECTIVES To compare the efficacy of diclofenac sodium with ketorolac tromethamine in reducing postoperative morphine use after major orthopedic surgery . DESIGN Double-blind , r and omized , placebo-controlled study . SETTING Major teaching institution . PATIENTS 102 ASA physical status II patients undergoing hip and knee replacement with general anesthesia . INTERVENTIONS Before induction of anesthesia , patients were r and omly allocated to receive intravenously either diclofenac sodium 75 mg ( Group D ) , ketorolac tromethamine 60 mg ( Group K ) , or placebo ( Group P ) . Patient-controlled analgesia was supplied postoperatively using morphine . MEASUREMENTS Visual analog scale ( VAS ) , verbal pain score ( VPS ) , sedation score , frequency of opioid side effects , and morphine consumption were recorded every 4 hours . MAIN RESULTS There was a highly 
    Output:
    
: Single dose systemic ketorolac is an effective adjunct in multimodal regimens to reduce postoperative pain .
Improved postoperative analgesia achieved with ketorolac was also accompanied by a reduction in postoperative nausea and vomiting .
The 60-mg dose offers significant benefits but there is a lack of current evidence that the 30-mg dose offers significant benefits on postoperative pain outcomes