344 Ketorolac use for postpartum pain management in women with inflammatory bowel disease (IBD)

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are known to have deleterious effects on small bowel and colonic mucosa. Obstetricians have avoided using NSAIDs for postpartum pain in women with IBD. To achieve adequate pain relief, these patients often require opioids, which pose additional risks of dependence/abuse. Several studies have shown that oral Ibuprofen is the NSAID most associated with disease flare in the IBD population, yet no studies have evaluated IV Ketorolac for pain relief in women with IBD postpartum. We sought to investigate the risk of disease flare and efficacy of Ketorolac for pain relief during the immediate postpartum period in women with IBD. This was a retrospective cohort study of patients with IBD in pregnancy who delivered at a single tertiary care institution from 2012-2020. Of 366 patients in the cohort, 246 received IV Ketorolac. Visual analog pain score of 1-10 documented by nursing staff at standardized time points were extracted from EMR and compared between groups. IBD flare was defined as any documented flare symptom or admission for worsening disease within 6 weeks postpartum. Patients who received Ketorolac reported significantly lower pain scores (p=0.0035) and required less IV and PO opioid medications (p<0.0001) during hospital stay compared to those who did not. Incidence of IBD flare postpartum did not differ between groups nor based on mode of delivery. Following cesarean delivery, patients given Ketorolac had significantly lower peak pain scores (p<0.0001) and pain scores at 12 hours postpartum (p=0.03). A composite of post-operative complications (abscess, ileus, SBO, re-operation) were also significantly lower in the Ketorolac group (p=0.001). Ketorolac significantly decreases postpartum pain scores and opioid use in women with IBD, and most notably in women undergoing cesarean delivery. Ketorolac use was not associated with an increased risk of IBD flare postpartum. For women with IBD, Ketorolac should be considered for pain management in postpartum period, to optimize pain control and allow for reducing opioid use.View Large Image Figure ViewerDownload Hi-res image Download (PPT)