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Intravenous ketorolac effectively reduces fentanyl-induced cough, offering a safe and reliable alternative to lidocaine.
Fentanyl, a commonly used anesthetic agent, often provokes reflex coughing that can disrupt induction and patient comfort. Hence, this prospective, randomized, and double-blind study aimed to evaluate the efficacy of intravenous ketorolac in mitigating fentanyl-induced cough, positioning it as a potential alternative to lidocaine when its use is contraindicated.
The study included 210 patients undergoing elective surgical procedures under general anesthesia. All the volunteers were categorized as American Society of Anesthesiologists (ASA) physical status I or II, representing individuals with stable or mild systemic conditions. They were divided into 3 groups, each receiving a different pretreatment:
1. Group K: 0.5 mg/kg intravenous
2. Group L: 1 mg/kg intravenous lidocaine
3. Group N: 2 cc of 0.9% normal saline
The respective agents were administered 3 minutes before intravenous fentanyl (3 mcg/kg). After fentanyl administration, patients were observed for 3 minutes, and the onset and severity of cough were documented. Hemodynamic parameters—including heart rate, blood pressure (BP), and oxygen saturation (SpO2) —were continuously monitored to ascertain patient safety and assess intergroup variations. The onset time of cough differed markedly between the groups (P = 0.001). Severe cough occurred in 3 participants (4.3%) in group L and 9 participants (12.9%) in group N, indicating a prominent difference in cough severity among the groups (P = 0.001).
The heart rate and SpO₂ showed no vital differences between groups at any measured time points (P > 0.05). In contrast, arterial BP showed noticeable differences 3 minutes after fentanyl administration and 1 minute post-intubation (P = 0.003 and 0.001, respectively), with mean arterial BP being highest in group N, followed by group L, and lowest in group K. Hence, ketorolac emerged as a potent preventive strategy against fentanyl-elicited cough, markedly reducing both incidence and intensity. The results highlight its value in optimizing perioperative care, particularly for patients in whom lidocaine use is not feasible.
Anesthesiology and Pain Medicine
Prevention of Fentanyl Induced Cough by Ketorolac: A Prospective, Randomized, and Double-Blind Study
Nasrin Nouri et al.
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