Use of Toradol® in anorectal surgery

Toradol (ketorolac tromethamine; Syntex Labs, Palo Alto, CA) is a nonsteroidal anti-inflammatory drug introduced for intramuscular injection to control postoperative pain. Its action is peripheral. Therefore, it seemed appropriate to inject it directly into the anal sphincter muscles when these are exposed during anorectal procedures. A total of 60 mg (2 cc) are used, divided among the quadrants resected. Four hours postoperatively, 30 mg are given intramuscularly, and the patient is discharged. Any patient who required medication stronger than Darvocet-N-100 (propoxyphene napsylate and acetaminophen; Eli Lilly and Co., Indianapolis, IN) for pain was considered a failure. Seventeen of 100 patients (17 percent) failed to have their pain controlled. Unexpectedly, only two patients (2 percent) needed catheterization for urinary retention. The usual incidence is 20 to 30 percent. To date we have seen none of the complications associated with the use of anti-inflammatory drugs.