The Effect of Intravenous Ketorolac on Opioid Requirement and Pain After Cesarean Delivery

Abstract

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.

Cyclooxygenase-2 inhibition potentiates morphine antinociception at the spinal level in a postoperative pain model

“…Clinical studies have shown that systemic COX inhibitors when combined with epidural opioids improved postoperative pain relief 21,22 or decreased postoperative epidural opioid usage. 23 Besides potential species differences, the results of clinical studies may differ from our study because of a different route of drug administration (epidural versus intrathecal). Another important difference is that the clinical studies all involved cesarean delivery, with its inflammatory components, whereas the animal study uses an incisional wound pain model.…”

Postoperative analgesia following caesarean deliveries in a rural health district of South Africa

“…The use of pethidine alone deprives the parturients of the additional benefits of visceral pain relief provided by NSAID. 7,14 In addition, this practice may encourage the use of excessive dosages of opioids (which predispose to more side-effects) in order to achieve optimum analgesia. The most common determinant of the doctors' analgesic regimen was the hospital protocol (reported by almost half of the doctors).…”

Anesthesia for cesarean section in a patient with spinal muscular atrophy

“…A nonsteroidal antiinflammatory drug was given and an iliohypogastricilioinguinal block was performed to reduce opioid requirements postoperatively. 18,19 In summary, we report the anesthetic management for cesarean section of a parturient with SMA. An understanding of the pathophysiology of the disease and the implications of the changes of pregnancy is important for the delivery of a safe anesthetic and postpartum care.…”