A Double-Blind, Randomized Study Comparing Post- operative Pain Management Using Epidural Ropivacaine with Intravenous Ketorolac or Intravenous Ketorolac Alone Following Transabdominal Hysterectomy
THITIMA CHINACHOTI, M.D .* , ORATHAI TUNTISIRIN, M.D .*** , PRASONG KHUNSONGKIET, M.D .***** , ILUMINADA CAMAGAY, M.D .******
Affiliation : * Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, ** Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, *** Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, **** Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, ***** Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand. ****** Investigator Centers in Philippines.
SUPRANEE NIRUTHISARD, M.D .** , SOMBOON THIENTHONG, M.D .**** , FIDEL PAYAWAL, M.D .****** , RICARDO DE CASTRO, M.D .******
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.
Design : 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 com- bination 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.
Conclusion : We demonstrated that epidural infusion of ropivacaine in addition with intra- venous ketorolac gave superior pain relief at rest and on coughing in patients undergoing transabdo- minal hysterectomy when compared to the group receiving intravenous ketorolac alone.
Keywords : Ropivacaine, Ketorolac, Pain Controlled, Hysterectomy
