Analgesic efficacy of morphine versus concurrent use of ketorolac and Acetaminophen in mandibular bone surgery

Abstract

Background: Pain, a major issue in medical treatment, is one of the major concerns for both the clinician and the patient. Postoperative acute pain management during the initial hours is very important and can prevent side effects. Analgesics (acetaminophen, opioids) and nonsteroidal anti-inflammatory drugs are used as medications for pain control. Objective: This study was performed to compare the analgesic efficacy of morphine versus the concurrent use of ketorolac and intravenous acetaminophen after mandibular bone surgery. Materials and Methods: In this prospective, single-centered, randomized, double-blind clinical trial study, a total of 60 patients referred to Imam Reza Hospital in 2015 for mandibular bone surgery were randomized post-surgery into two groups: In group 1, acetaminophen (1 g in 100 cc normal saline solution) and ketorolac (30 mg in 100 cc normal saline solution) were infused every 6 hours. In group 2, morphine sulfate (0.1 mg/kg in 100 cc normal saline solution) was infused every 4 hours. The pain level was recorded on the visual analogue scale (VAS) at 1, 2, 4, 6, 12, and 24 hours after surgery. Results: Significant differences were found between the two groups in most hours. The mean pain level according to the VAS in group 1 and group 2 were 6.87±2.43 vs.7.20±2.06 (p = 0.560) for the 1 st hour post operation, 5.80±2.76 vs. 4.03±2.25 (p = 0.008) for the 2 nd hour post operation, 5.03±3.01 vs. 3.10±2.11 (p = 0.005) for the 4 th hour post operation, 3.37±3.03 vs. 1.77±1.92 (p = 0.017) for the 6 th hour post operation, 2.10±2.44 vs. 0.73±1.28 (p = 0.008) for the 12 th hour post operation and 1.30±1.91 vs. 0.60±1.28 (p = 0.101) for the 24 th hour post operation. No significant difference was observed in the 1 st and 24 th hour post-operation. Nausea was seen in the groups as one of the side effects with no significant difference. Conclusion: Morphine showed better efficiency in pain control than the concurrent use of ketorolac and intravenous acetaminophen.