Tramadol Versus Ketorolac in the Treatment of Postoperative Pain Following Maxillofacial Surgery

Abstract

Pain plagues daily activity and hence its management would require alleviation at both the mental and physical planes, thus, bringing about comfort. It includes delivering analgesics in parenteral or oral form, or patches depending on the intensity and availability. Best analgesic regimens are ones that offer broad coverage, easy to administer, safe and economical. A drug seemingly appropriate to treat moderate to severe pain would be Tramadol hydrochloride, a centrally acting synthetic opioid analgesic with lower opiate-like dependence than Morphine. Ketorolac, a pyrrolo-pyrrole derivative, possesses analgesic, antiinflammatory and anti-pyretic activity would also appear equally suitable. Fifty adult ASA grade I and II patients undergoing surgery under GA in the Department of Oral & Maxillofacial Surgery, College of Dental Sciences, Davangere, were included. Ketorolac (30 mg IM) for 25 patients and Tramadol (100 mg IM) for 25 patients were administered at the time of skin closure and repeated after 8 and 16 h from the conclusion of surgery. Pain, using the VAS at the 2nd, 4th, 6th, 12th and 24th post-operative hour, was assessed and compared using v 2 -test. Vitals were monitored and adverse events were looked for. Though both the drugs resulted in significant decrease in pain intensity from the 2nd to 24th post-operative hour, Tramadol always resulted in better pain control than Ketorolac at every postoperative hour (P \ 0.050). To conclude, intramuscular Tramadol seemed useful in controlling pain following surgery, with better levels of tolerance than intramuscular Ketorolac. However, both the drugs produced mild side effects but did not appear to influence the outcome.

Oral Ketorolac with Inferior Alveolar Nerve Block for Irreversible Pulpitis: A Systematic Review and Meta-analysis

“…Ketorolac has been a preferred due to its advantages over other NSAID’s. These include less likely alterations to the bleeding time, less likely to cause acute renal failure in patients with pre-existing renal impairment, less likely combination reactions when co-administered with other drugs and single dose administration [ 20 ]. Considering the advantages of ketorolac over other NSAID’s this systematic review and meta-analysis identified the anaesthetic efficacy of inferior alveolar nerve block after pre-medication with ketorolac.…”

Effects of ketorolac versus pethidine on the management of postoperative acute pain and complications after hemorrhoidectomy

“…Shankariah et al reported that the mean post-cesarean pain intensity was significantly lower in subjects who received ketorolac as an NSAID and tramadol as an opioid, compared to patients who received placebo. In addition, a more significant difference was observed between subjects who consumed tramadol and those who consumed ketorolac (23).…”

A Comparative Evaluation Between Intravenous Ketorolac Versus Intramuscular Methadone for Analgesia after Laminectomy

“…Elia (2005) argued that NSAIDs have a better effect on pain relief compared to opioids. Shankariah et al (2012) compared the effect of IM injection of Ketorolac and Tramadol, and found that both of these drugs reduced pain intensity from 2 to 24 hours postoperatively, but tramadol was always more effective in pain control compared to Ketorolac. Although ketorolac and methadone both reduce pain, we found in our study, Ketorolac reduced more pain as compared to methadone.…”