Evaluation of the preemptive administration of venous ketamine or ketorolac on pain relief after cesarean section under spinal anesthesia

Abstract

Background: This study aimed to compare the preemptive effect of intravenous ketorolac and ketamine on decreasing the pain of patient in cesarean surgeries. Methods: In a clinical trial study, 150 patients undergoing cesarean surgery were selected and randomly divided into three equal groups of the ketorolac, ketamine, and placebo. A stat dose of 15 mg ketorolac, continuing as 10 mg/hour till end of the surgery, a stat dose of 0.25 mg/kg ketamine continuing as 10 mg/hour till end of the surgery, and the same amount of normal saline was injected in the three groups, respectively. Postoperative pain intensity, analgesic requirement, hemodynamic changes during and after surgery, and adverse effects were compared between the three groups. Findings: The mean score of postoperative pain in ketorolac group was significantly lower in the return time of motor block, and 4, 12, and 24 hours later than ketamine and at 4, 12, 24 hours than placebo group (P < 0.05 for all). Mean systolic blood pressure was lower in ketorolac group in different periods of surgery and in recovery period (P < 0.05). Mean diastolic blood pressure was lower in ketorolac group in different periods during the surgery (P < 0.05), but ketamine group had lower diastolic blood pressure in recovery period (P < 0.05). Incidence of hypotension, respiratory depression, cardiac arrhythmia, and hallucination were equal in three groups; but flushing, shiver, and nausea and vomiting were lower in ketorolac group (P < 0.05). Conclusion: Injection of ketorolac as preemptive treatment could decrease postoperative pain intensity in patients who undergo cesarean surgery. It also has some cardiovascular protective effect and decrease incidence of flushing, shiver, and nausea and vomiting after surgery. So, we recommend preemptive use of ketorolac in cesarean surgeries. © 2018, Isfahan University of Medical Sciences(IUMS). All rights reserved.