title: A double-blind, randomized study comparing postoperative pain management using epidural ropivacaine with intravenous ketorolac or intravenous ketorolac alone following transabdominal hysterectomy.
abstract: OBJECTIVE
  The aim of this study is to compare the effect on postoperative pain of epidural ropivacaine in combination with intravenous ketorolac with intravenous ketorolac alone following transabdominal hysterectomy.
  
  
  METHODS
  A multi-center, randomized, double-blind study was conducted in Thailand and the Philippines to assess postoperative pain management in 107 patients given ketorolac alone or in combination with epidural ropivacaine following transabdominal hysterectomy. Pain score was assessed using a 100-mm visual analogue pain scale (VAS).
  
  
  RESULTS
  The VAS scores for pain on coughing and at rest were significantly better in the ropivacaine group. The number of patients who asked for morphine in addition was higher in the ketorolac group compared to the ropivacaine + ketorolac group. The time taken to carry out the first three ambulatory steps was similar for both the two treatment groups. A higher degree of motor block was observed in the ropivacaine group over time. The adverse events observed were similar in both groups.
  
  
  CONCLUSIONS
  We demonstrated that epidural infusion of ropivacaine in addition with intravenous ketorolac gave superior pain relief at rest and on coughing in patients undergoing transabdominal hysterectomy when compared to the group receiving intravenous ketorolac alone.
authors.affiliation: Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
authors.forename: Thitima
authors.initials: T
authors.lastname: Chinachoti
authors.forename: Supranee
authors.initials: S
authors.lastname: Niruthisard
authors.forename: Orathai
authors.initials: O
authors.lastname: Tuntisirin
authors.forename: Somboon
authors.initials: S
authors.lastname: Thienthong
authors.forename: Prasong
authors.initials: P
authors.lastname: Khunsongkiet
authors.forename: Fidel
authors.initials: F
authors.lastname: Payawal
authors.forename: Iluminada
authors.initials: I
authors.lastname: Camagay
authors.forename: Ricardo
authors.initials: R
authors.lastname: De Castro
mesh_terms: D000577:Amides / Q000627:therapeutic use*; D000767:Anesthesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D019540:Area Under Curve; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007262:Infusions, Intravenous; D020910:Ketorolac / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D010679:Philippines; D000077212:Ropivacaine; D018709:Statistics, Nonparametric; D013785:Thailand; D016896:Treatment Outcome; D016138:Walking
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000077212:Ropivacaine; D020910:Ketorolac