Ketorolac-based patient-controlled analgesia can serve as a viable alternative to fentanyl-based PCA for postoperative nausea and vomiting in microvascular decompression procedure.

Patients after microvascular decompression (MVD) often complain of postoperative nausea and vomiting (PONV). This study compared ketorolac-based with fentanyl-based patient-controlled analgesia (PCA) for PONV and pain relief after the MVD procedure.

From December 2021 to February 2023, a prospective, double-blind, single-centre, randomized controlled trial was carried out, enrolling patients who underwent MVD and were randomly assigned to either the ketorolac- or fentanyl-based patient-controlled analgesia (PCA) group for postoperative management.

The primary outcome was the incidence of PONV, along with its severity and the need for rescue antiemetics within the initial 48 hours after the surgery. Furthermore, pain scores, requirement for rescue analgesia, use of PCA, and satisfaction scores were evaluated throughout the study period. The severity of PONV and pain after the procedure were rated on an 11-point numeric scale, while satisfaction scores ranged from 0 (very dissatisfied) to 10 (very satisfied).The Chi-square (approximations) or Fisher's exact test was used to examine the categorical variables and the T-test or Mann-Whitney U-test was used for continuous variables.

After the screening of 185 patients, 91 were excluded based on predetermined criteria, leaving 87 patients. They were categorized as ketorolac group (43 patients) and fentanyl group (44 patients) with no notable differences in demographic characteristics between the groups.

The incidence of PONV (48.8% versus 79.5%, p = 0.003) and its severity (p = 0.004) were considerably lower in the ketorolac group compared to the fentanyl group. Moreover, the ketorolac group exhibited a notable decrease in the need for rescue antiemetics (p = 0.049). 

Furthermore, fewer withdrawals were observed in the ketorolac group than in the fentanyl group (p = 0.001), with insignificant differences in pain levels after surgery between these groups.

Ketorolac-based PCA showed reduced PONV incidence and severity compared to fentanyl-based PCA while demonstrating analgesic efficacy similar to fentanyl-based PCA for individuals undergoing MVD.