Effect of Preemptive Analgesia with Ketorolac on Intra and Post Operative Opioid Requirements in Patients Undergoing Total Abdominal Hysterectomy

Abstract

Objective: Pre-emptive analgesia may prevent or reduce hyper-analgesia, inhibit inflammation
and reduce pain by blocking the synthesis of prostaglandins in response to tissue damage
caused by surgery. NSAIDS are used frequently for treatment of post-surgical pain along with
opioids. However, they may not be as effective as opioids. Ketorolac (one of the NSAIDS) used
post-operatively can be used for pre-emptive analgesia to reduce opioid requirements in patients
undergoing total abdominal hysterectomy (TAH).
Material and Methods: This was a double blind controlled trial with random allocation. After
approval from hospital ethics committee, seventy ASA I and II patients between the ages of 40-
60 years undergoing total abdominal hysterectomy (TAH) were included in the study after
informed consent. They were divided into two equal groups (35 patients in each group). Each
patient was shown the VAS (Visual Analogue Scale) preoperatively and explained how to rate her
severity of pain on the scale. Thirty five patients, preemptive group (P group) received 30 mg of
Ketorolac and 35 patients, control group (C group) received placebo (saline) intravenously (I.V)
30 minutes before induction of anesthesia. Intra-operatively, an increase in blood pressure and
heart rate were taken as an indicator of pain during surgery and Injection Nalbuphine 0.05-mg/kg
was administered as rescue analgesia. Postoperatively, for the initial 24 hours, pain was
assessed on a VAS (VAS-score) of 1-3 considered as mild pain, 4-7 as moderate pain & 8-10 as
severe pain). If score was more than 3 a top up dose of Inj. Nalbuphine 0.05 mg/kg was
administered intravenously. Total Nalbuphine consumption during the intraoperative as well as
initial 24 hours postoperative period was recorded for each patient.
Results: Thirty five patients in study group (P group) and 35 patients in the control group (C
group) completed the study. Overall, there was no statistically significant difference in pain scores
as well as opioid requirements in both these groups. (P > 0.05).
Conclusion: The results suggested that there was no decrease in opioid requirements in
patients who received Inj. Ketorolac pre-emptively, therefore Ketorolac has little or no place as a
preemptive analgesic.