The effect of intravenous ketorolac on opioid requirement and pain after cesarean delivery.
Nonsteroidal antiinflammatory drugs, including ketorolac, are widely used for postoperative analgesia. This randomized, double-blinded trial compared IV ketorolac or saline combined with meperidine patient-controlled epidural analgesia (PCEA) after cesarean delivery. Fifty healthy parturients scheduled for elective cesarean delivery under combined spinal-epidural anesthesia received PCEA plus either IV ketorolac (Group K) or saline (Group C) for 24 h. The ketorolac dose was modified, after six patients had been studied, based on new product information recommending a maximum of 120 mg ketorolac over 24 h. Group K (n = 24) and Group C (n = 20) were demographically similar. During the first 24 h, Group K used significantly less meperidine (P < 0.05). Postoperative pain at rest and with movement, and patient satisfaction, did not differ significantly between groups, except that worst pain at 12 h was less in Group K (P < 0.005). The two groups were similar with respect to patient recovery and side effects. IV ketorolac, as an adjunct to PCEA after cesarean delivery, produced a meperidine dose-sparing effect of approximately 30%, but did not significantly improve pain relief, reduce opioid-related side effects, or change patient outcome.
Pavy
T J
TJ
Department of Anaesthesia and Women and Infants Research Foundation, King Edward Memorial Hospital for Women, Subiaco 6008, Western Australia, Australia.
Paech
M J
MJ
Evans
S F
SF
D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D002585:Cesarean Section; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D020910:Ketorolac / Q000008:administration & dosage / Q000627:therapeutic use*; D008614:Meperidine / Q000008:administration & dosage / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D008614:Meperidine; D020910:Ketorolac