Nausea Management after Analgesia with ‎Ketorolac and ‎Morphine: Case Study of Septorhinoplasty Patients

Nausea Management after Analgesia with ‎Ketorolac and ‎Morphine: Case Study of Septorhinoplasty Patients


  • Mojtaba Sohrabpour Assistant Professor of Otorhinolaryngology, Head and Neck Surgery, Department of Otorhinolaryngology, Vali Asr Hospital, Fasa University of Medical Science, Fasa, Iran.
  • Mojtaba Ghaedi Assistant Professor of Plastic Surgery, Department of Surgery, Jahrom University of Medical Sciences, Jahrom, Iran.
  • Seyed Ebrahim Sadeghi Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran.
  • Reza Sahraeai Department of Anesthesiology, Jahrom University of Medical Sciences, Jahrom, Iran.
  • Mohammad Sadegh Sanie Jahromi Department of Anesthesiology, Jahrom University of Medical Sciences, Jahrom, Iran
  • Navid Kalani Department of Anesthesiology, Jahrom University of Medical Sciences, Jahrom, Iran.


ketorolac, morphine, postoperative nausea, septorhinoplasty


Introduction: Patients undergoing plastic surgery are at increased risk for PONV. This ‎complication may have disastrous effects such as hematoma or suture disruption and destroy ‎the desired aesthetic result. The present study was conducted with the aim of investigating and ‎comparing the rate of postoperative nausea in patients receiving ketorolac and morphine, ‎and undergoing septorhinoplasty surgery.‎

Materials and methods: This study is a double-blind randomized clinical trial that was ‎conducted during a six-month period from March ‎‏2021‏‎ to August ‎‏2022‏‎ in 180 patients referred ‎to the operating room of Motahari Hospital in Jahrom city who underwent septorhinoplasty ‎surgery. , Done. Patients were randomly divided into three groups: 15 mg/kg morphine and 30 ‎and 60 mg ketorolac. Information collection tools include; Age, gender and degree of nausea ‎after the operation.‎

Results: The studied groups are similar in terms of age, sex and demographic characteristics. In ‎terms of nausea, Fisher's statistical test showed that patients in the group receiving 6 mg of ‎morphine felt nausea, which was statistically significant (P=0.035). No person in the group ‎receiving ketorolac 60 mg and ketorolac 30 mg experienced nausea.‎

Conclusion: Based on the results of the present study, the use of doses of 30 and 60 mg of ‎ketorolac, unlike morphine, did not cause nausea in septorhinoplasty patients receiving this ‎drug.‎


We would like to thank the Clinical Research Development Unit of Peymanieh Educational and ‎Research and Therapeutic Center of Jahrom University of Medical Sciences for providing facilities for ‎this work.‎

Authors Contributions:

Seyed Ebrahim Sadeghi contributed to the data analysis and interpretation. Reza Sahraeai and Mohammad Sadegh Sanie Jahromi provided critical feedback and helped to shape the research. Navid Kalani assisted with data collection and analysis. Mojtaba Ghaedi contributed to the literature review and writing of the manuscript. Mojtaba Sohrabpour oversaw the project and provided guidance throughout the research process.‎

Conflict of interest:

There are no conflicts of interest in this study.‎

Research funding: None.

Ethical consideration:

This study was approved by ethics in research committee with a code of: IR.JUMS.REC.1400.043

Data availability:

No data are available for this review study.


‎ 1.Ebrahimi A., Kalantar Motamedi M.H., Shams A., Nejadsarvari N., Health and social problems of rhinoplasty in Iran. World Journal of Plastic Surgery, 2016, 5:75

Sari A.A., Babashahy S., Olyaeimanesh A., Rashidian A., Estimating the frequency and rate of first 50 common types of invasive procedures in iran healthcare system. Iranian Journal of Public Health, 2012, 41:60

Gan TJ et al (2014) Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 118:85–113

Apfel CC, Laara E (1999) A simplified risk skor for predicting postoperative nausea and vomiting. Anesthesiology 91:693–700

Marcus JR, Few JW. The prevention of emesis in plastic surgery: a randomized prospective study. Plast Reconstr Surg. 2002; 109:2487–2494

Watcha MF, White PF. Postoperative nausea and vomiting: its etiology, treatment and prevention. Anesthesiology.1992; 77:162–184

Steely RL, Collins DR, Cohen BE et al. Postoperative nausea and vomiting in the plastic surgery patient. Aesth Plast Surg.2004; 28:29–32

zychta P, Antoszewski B. Assessment of early postoperative pain following septorhinoplasty. J Laryngol Otol.2010; 124(11):1194–1199.

Wittekindt D, Wittekindt C, Schneider G, Meissner W, GuntinasLichius O. Postoperative pain assessment after septorhinoplasty. Eur Arch Otorhinolaryngol. 2012; 269(6):1613–1621.

George JA, Lin EE, Hanna MN, Murphy JD, Kumar K, Ko PS, et al. The effect of intravenous opioid patientcontrolled analgesia with and without background infusion on respiratory depression: A meta-analysis. J Opioid Manag. 2010; 6: 47-54

Gupta A, Bah M. NSAIDs in the treatment of postoperative pain. Curr Pain Headache Rep. 2016;20:62.

Marret E, Kurdi O, Zufferey P, Bonnet F, Warltier D. Effects of nonsteroidal antiinflammatory drugs on patient-controlled analge- sia morphine side effects: meta-analysis of randomized controlled trials. Anesthesiology. 2005;102(6):1249–1260.

Ng A, Parker J, Toogood L, Cotton BR, Smith G. Does the opioid-sparing effect of rectal diclofenac following total abdom- inal hysterectomy benefit the patient? Br J Anaesth. 2002;88

(5):714–716. doi:10.1093/bja/88.5.714

Gan TJ, Joshi GP, Zhao SZ, Hanna DB, Cheung RY, Chen C. Presurgical intravenous parecoxib sodium and follow-up oral valdecoxib for pain management after laparoscopic cholecys- tectomy surgery reduces opioid requirements and opioid-related adverse effects. Acta Anaesthesiol Scand. 2004;48(9):1194–1207.

Elia N, Lysakowski C, Tramèr M. Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials. Anesthesiology. 2005;103 (6):1296–1304.

Jones SF, O'Donnell AM. Clinical pharmacology: Traditional NSAIDs and selective COX-2 inhibitors. In: Macintyre PE, Walker SM, Rowbotham DJ, editors. Clinical pain management (Acute pain). 2nd ed. London, UK: Hodder and Stoughton Limited; 2008: 168

Kotagal M, Hakkarainen TW, Simianu VV, Beck SJ, Alfonso-Cristancho R, Flum DR. Ketorolac use and postoperative complications in gastrointestinal surgery. Ann Surg 2016; 263(1): 71-5.

He A, Hersh EV. A review of intranasal ketorolac tromethamine for the short-term management of moderate to moderately severe pain that requires analgesia at the opioid level. Curr Med Res Opin 2012; 28(12): 1873-80.18.

Rettinger G., Risks and complications in rhinoplasty, GMS current topics in otorhinolaryngology, head and neck surgery, 2007, 6.

Fanous N., Brousseau V.J., Karsan N., Fanous A., Predicting the results of rhinoplasty before surgery: Easy noses versus difficult noses, Canadian Journal of Plastic Surgery, 2008, 16:69

Sykes J.M., Toriumi D., Kerth J.D., A devitalized tooth as a complication of septorhinoplasty, Archives of Otolaryngology– Head & Neck Surgery, 1987, 113:765

Abdoli A, Ghahramani S, Seif-Rabiei MA, Heshmati B, Salimi R. Comparison of the Effect of Ketorolac and Morphine on Pain Management in Patients with Spinal Trauma in Emergency

Department: A Randomized Controlled Clinical Trial Study. J Isfahan Med Sch 2019; 37(528): 556-63.

Pourfakhr P, Raaefi V, Najafi A, Shariat Moharari R, Etezadi F, Orandi A et al . Evaluation of postoperative analgesic effects of gabapentin and ketorolac after Orthognathic surgeries. Tehran Univ Med J. 2016; 73 (11) :812-818

Akhavan Akbari G, Entezari Asl M, Ghazi A, MirzaRahimy T, mirzai M. comparative study of the infusion of ketorolac and acetaminophen in reducing postoperative pain and opioid consumption in patients undergoing orthopedic surgery of the lower limbs. JAP 2018; 9 (1) :31-43

Vlajkovic G, Sindjelic R, Stefanovic I. Ketorolac as a pre-emptive analgesic in retinal detachment surgery: a prospective, randomized clinical trial. Int J Clin Pharmacol Ther 2007; 45(5): 259-63

Saryazdi H, Aghadavoudi O, Fakhari S. Comparison of the preemptive effect of intravenous paracetamol and ketorolac on prevention of postoperative pain in patients undergoing abdominal surgery. Journal of Isfahan Medical School. 2017 Sep 23;35(442):978-85.

Vadivelu N, Gowda AM, Urman RD, et al. Ketorolac tromethamine - routes and clinical implications. Pain Pract. 2015; 15: 175- 193.

Vadivelu N, Chang D, Helander EM, et al. Ketorolac, oxymorphone, tapentadol, and tramadol: a comprehensive review. Anesthesiol Clin. 2017; 35: e1- e20.

Rodriguez LA, Cattaruzzi C, Troncon MG, Agostinis L. Risk of hospitalization for upper gastrointestinal tract bleeding associated with ketorolac, other nonsteroidal anti-inflammatory drugs, calcium antagonists, and other antihypertensive drugs. Arch Intern Med. 1998; 158: 33- 39.




How to Cite

Sohrabpour, M., Ghaedi, M., Sadeghi, S. E., Sahraeai, R., Sanie Jahromi, M. S., & Kalani, N. (2023). Nausea Management after Analgesia with ‎Ketorolac and ‎Morphine: Case Study of Septorhinoplasty Patients. Updates in Emergency Medicine, 2(2). Retrieved from



Research Study

Most read articles by the same author(s)