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In cesarean section patients, 6 scheduled doses of Ketorolac substantially reduce opioid use.
An extended Ketorolac prescription considerably reduced the amount of morphine milligramme equivalents (MME) used following C-section, according to a single-center, randomized, double-blind study. Researchers aimed to determine whether prolonging the planned Ketorolac use would be effective in lowering post-C-section opioid consumption.
All participants undergoing C-section with neuraxial anesthesia who did not have a hypertensive disease were approached for recruitment. Volunteers were administered two 30 mg Ketorolac doses intravenously after surgery. They were randomly assigned to get 4 further doses of 30 mg of Ketorolac intravenously or a placebo every 6 hours.
All trial volunteers received opioids and acetaminophen as required. Total MME utilized in the first 72 hours postoperatively was the major endpoint. The number of patients who did not take opioids after surgery, postoperative satisfaction with inpatient care and pain management, postoperative changes in creatinine and hematocrit, and postoperative pain ratings were all considered secondary outcomes. A total of 74 samples in each group (n = 148) were planned.
Screening of 245 patients was done and a total of 148 patients were randomized (74 patients in each group). Between groups, the patients' characteristics were comparable. Contrasted to the placebo group (median 60.0, interquartile range [IQR] 30.0 to 112.5), prolonged Ketorolac prescription substantially reduced the usage of MME following C-section (median 30.0, IQR 0.0 to 67.5).
Additionally, individuals who had their Ketorolac prescriptions for a longer period of time were less likely to have pain scores higher than 3 out of 10. Compared to placebo, long-term Ketorolac use did not considerably decrease hematocrit on postoperative (POD) 1. In comparison with the placebo group, the Ketorolac group exhibited less of an alteration in serum creatinine between POD1 and 2 (1.6% vs 5.1% rise).
Subjects in both groups experienced comparable levels of satisfaction with inpatient pain management and postoperative care. Hence, six planned Ketorolac doses are beneficial to minimize opioid use following cesarean delivery.
American Journal of Obstetrics & Gynecology
Opioid use after cesarean with and without scheduled Ketorolac administration: a randomized control trial
Jean C. Hostage et al.
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