Plasma levels of interleukin-6 and interleukin-10 are affected by ketorolac as an adjunct to patient-controlled morphine after abdominal hysterectomy

Clin J Pain. 2001 Mar;17(1):72-7. doi: 10.1097/00002508-200103000-00010.


Objective: Because morphine affects various immune functions, patient-controlled analgesia with morphine may further deteriorate the immune mechanisms after surgery. Therefore, the purpose of this study was to determine differences between morphine patient-controlled analgesia and a combination of morphine and ketorolac in interleukin-6 and interleukin-10 responses, and in analgesia and morphine-related side effects.

Design: Prospective study.

Patients: Twenty-two patients who underwent abdominal hysterectomy were classified randomly into two groups: (1) patient-controlled analgesia with morphine; and (2) patient-controlled analgesia with a combination of morphine and ketorolac. Blood samples to measure cytokines were collected at preoperatively, immediately postoperatively, and 2 hours, 4 hours, and 24 hours postoperatively.

Outcome measures: Plasma was separated and frozen until the analysis of cytokines using enzyme-linked immunosorbent assays. Postoperative pain was assessed using a visual analog score. Sedation was checked based on a protocol developed at the Samsung Medical Center.

Results: In the two groups, interleukin-6 increased immediately postoperatively, and it remained consistent for 24 hours. Interleukin-10 concentrations peaked at 2 hours postoperatively and progressively decreased. Cytokine concentrations between the two groups were significantly different for interleukin-6 24 hours postoperatively (p = 0.026) and for interleukin-10 4 hours postoperatively (p = 0.045). Total analgesic use was not different, but morphine consumption was significantly different (p = 0.037 at 4 hours postoperatively, p = 0.015 at 24 hours postoperatively). Pain scores, sedation, and side effects were unaffected by the patient-controlled analgesia regimen.

Conclusions: The authors conclude that supplementation using ketorolac plus administration of morphine modifies cytokine responses and may contribute to immune augmentations during postoperative periods.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Abdomen / surgery
  • Adult
  • Analgesia, Patient-Controlled*
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Drug Therapy, Combination
  • Female
  • Humans
  • Hysterectomy / methods*
  • Interleukin-10 / blood*
  • Interleukin-6 / blood*
  • Ketorolac / therapeutic use*
  • Middle Aged
  • Morphine / administration & dosage
  • Morphine / therapeutic use
  • Osmolar Concentration
  • Postoperative Care*
  • Prospective Studies


  • Analgesics, Opioid
  • Anti-Inflammatory Agents, Non-Steroidal
  • Interleukin-6
  • Interleukin-10
  • Morphine
  • Ketorolac