Abstract
The study was designed to compare the analgesic efficacy and safety of ketorolac and pethidine in pain relief after major surgeries. A prospective, interventional study was conducted on 71 patients under-going major surgical intervention. Thirty six patients received ketorolac (15 mg, intramuscularly 6 hourly) and the rest 35 patients received pethidine (100 mg, intramuscularly 6 hourly) for 48 hours post-operatively. Analgesic efficacy and safety of ketorolac were compared with that of pethidine after 1, 6, 12, 24, 32 and 48 hours of drug administration. Analgesic efficacy was measured using Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS). Safety of the drugs was assessed by using sedation score and also recording adverse drug events. Ketorolac showed equianalgesic effect as pethidine estimated by VAS score at 12th and 48th hour and by VRS score at 1st and 48th hour of post-operative period. In other periods of observation, pethidine exhibited better analgesic effects than ketorolac. Ketorolac was better tolerated than pethidine and had less adverse effects compared to pethidine. This study showed that post-operative pain during the first 48 hours can be relieved by either ketorolac or pethidine. Ketorolac appeared safer than pethidine while pethidine appeared more effective analgesic than ketorolac in the management of post-operative pain. Further studies including double-blind randomized trial have been suggested to confirm the present study.
Highlights
Surgical operations are associated with pain, which may amplify endocrine and metabolic responses, autonomic reflexes, nausea, ileus and muscle spasm and thereby may increase post-operative morbidity and mortality (Kehlet, 1999)
Pethidine group received pethidine (100 mg, intramuscularly) at the end of operation and 6 hourly for 48 hours in the post-operative period. Analgesic efficacy of both drugs in the groups was measured by Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS)
This study showed that intramuscular ketorolac is safer than intramuscular pethidine in post-operative pain relief after major surgery and suggested that the analgesic effect of intramuscular ketorolac is comparable with the effect of pethidine in same postoperative setting
Summary
Surgical operations are associated with pain, which may amplify endocrine and metabolic responses, autonomic reflexes, nausea, ileus and muscle spasm and thereby may increase post-operative morbidity and mortality (Kehlet, 1999). Optimal post-operative pain treatment is mandatory to enable early mobilization and rehabilitation, to enhance recovery and to reduce morbidity. Despite continuous advances in anesthesia and post-operative pain management, reviews of the literature showed that there are still a significant number of patients who experience severe or moderate pain after surgery (Kuhn et al, 1990; Bruster et al, 1994; Oates et al, 1994). In spite of availability of effective methods of controlling acute pain, the efficacious treatment of postoperative pain is a serious deficiency in modern health care (Porter and Jick, 1980). A number of drugs are available for post-operative pain management. Effectiveness of non-steroidal antiinflammatory drugs (NSAIDs), e.g. ketorolac, diclofenac, ibuprofen, indomethacin, tenoxicam in managing
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