Pain management in the postoperativ...

Pain management in the postoperative period usually consists of opioids, other powerful analgesics, or both. These medications have been proven to provide suitable pain control but have a significant number of potential side events Some of these side events include nausea, vomiting, constipation, pruritus, urinary retention, respiratory depression, and sedation. Nonsteroidal anti-inflammatory physics (NSAIDs) provide anti-inflammatory and analgesic meanings but because most are oral or rectal preparations the ability to use NSAIDs in the postoperative period is limited.

Ketorolac tromethamine is an NSAID that, because of its unique properties, can be administered intravenously, intramuscularly, or orally. Ketorolac has no significant cardiovascular, central nervous connected view or autonomic nervous system activity. In addition, ketorolac has an analgesic validity similar to that of the more commonly used opioids and has been shown to be effective in certain postoperative cases. However, because of the normal changes related to contortion distribution in gravid patients, its effectiveness in postcesarean patients is questioned. Lowder and associates evaluated the use of ketorolac for postoperative pain management in patients who had undergone cesarean delivery.

The trial was a randomized, double-blind, placebo-controlled close attention of patients requiring cesarean delivery. Exclusion criteria included patients with bleeding disorders; renal disease; gastrointestinal sore s bleeding, or perforation; asthma; known allergy or hypersensitivity to the meditation drug, aspirin, or other NSAIDs; and breastfeeding status. Patients randomly received ketorolac or placebo pretty soon after the procedure and each six hours for two doses. In addition, they were placed upon patient-controlled analgesia (PCA) using various opioids. Pain was assessed each hour for the first four hours after the deed and then at six, 12 and 24 hours using visual analog scales (VAS). The main results measured included VAS scores, PCA attempts, PCA dosages admin-istered, time to discharge, and preoperative and postoperative hematocrit levels

The contemplation included 22 patients each in the treatment and placebo arms. The pair groups did not differ significantly with regard to demographics, relations loss, or type of anesthesia. In addition, the sum of two units groups did not differ with regard to hours of PCA use or time to discharge. Those treated with ketorolac had significant postoperative improvement onward VAS scores at two, three four, six, 12 and 24 hours. When morphine equivalents were compared, patients who received ketorolac had a significantly lower total dosage than those who received placebo. Patients in the placebo dispose used nearly 50 percent more morphine equivalents than the ketorolac assign places to When PCA attempts were compared, there was no significant difference between the sum of two units groups.

The authors end that ketorolac tromethamine is effective in reducing postoperative pain and narcotic use in patients who have undergone cesarean delivery. They add that this medication has been shown to be safe in the postoperative period. They also note that the U diet and Drug Administration currently does not approve the use of ketorolac in breastfeeding patients, on the same level though the American Academy of Pediatrics has plant ketorolac to be compatible with breastfeeding.

KARL E MILLER, MD Lowder JL et al. A randomized, controll trial to compare ketorolac tromethamine versus placebo after cesarean section to contract pain and narcotic usage. Am J Obstet Gynecol December 2003;189:1559-62

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