Ketorolac is a parenteral NSAID that produces analgesia by reducing prostaglandin formation via

inhibition of the enzyme cyclooxygenase (COX). Intraoperative use of ketorolac reduces

postoperative need for opioids. Two forms of cyclooxygenase have been identified: COX-1 is
responsible for the synthesis of several prostaglandins as well as prostacyclin (which protects gastric
mucosa), and thromboxane, which supports platelet function. COX-2 is induced by inflammatory
reactions to produce more prostaglandins. Ketorolac (as well as many oral NSAIDs, aspirin, and
indomethacin) inhibits both COX-1 and COX-2, which causes the major side effects of gastric
bleeding, platelet dysfunction, and hepatic and renal damage. Parecoxib is a parenteral COX-2 NSAID
now being tested which would presumably produce analgesia and reduce inflammation without
causing gastrointestinal bleeding or platelet dysfunction.