Effect of Intravenous Ketorolac on Postoperative Pain after Cesarean Section: A Randomized Double-Blinded Controlled Trial
Pailin Kasemsin MD*, Komsun Suwannarurk MD*, Densak Pongrojpaw MD*, Athita Chanthasenanont MD*, Supapen Lertvutivivat MD*, Junya Pattaraarchachai PhD**, Kornkarn Bhamarapravatana PhD***
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand ** Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand *** Department of Preclinical Science, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Objective : Ketorolac is occasionally administrated for post cesarean delivery analgesia. The clinical efficacy of ketorolac for
post cesarean analgesia had never been directly compared to meperidine. The purpose of the present study was to determine
the efficacy of ketorolac for pain control in post cesarean delivery compare to meperidine.
Material and Method: This was a randomized double-blind controlled trial comparing the effectiveness of intravenous
ketorolac compared to meperidine. The inclusion criteria were term pregnant women who were 18 to 40 years old and
underwent cesarean delivery. The subjects were randomly divided into study and control groups. The study and control group
received 30 mg of ketorolac and 50 mg of meperidine intravenously after surgery, respectively. Visual analog score (VAS) was
used to assess the post operative pain ranged from 0 to 10. VAS was recorded at 3, 6, 12 and 24 hours postoperatively.
Demographic data of parturient, newborn and side effects were also recorded.
Results : A total of 580 cases were recruited. There were 297 and 283 cases in study and control group. Both groups showed
no statistical difference in mean age, gestational age, fetal weight, parity. Either ketorolac or meperidine group showed no
significant post operative pain relief at 3, 6, 12 and 24 hours. After first initial post-operative pain assessment, 8% (24/297)
and 7.4% (24/283) of participants needed and received rescue analgesia. Subjects in both groups who had VAS equal or more
than six had equally post operative pain relief either by ketorolac or meperidine. There was no maternal, fetal complications
and serious side effect in the present study.
Conclusion : Ketorolac had equal efficacy to meperidine. It could be an alternative medication for pain control in post
cesarean delivery.
Keywords : Ketorolac, Cesarean delivery, Pain, Meperidine
