ABSTRACT
Objective: Primary objective was to compare the frequency and severity of pain in propofollignocaine only regimens with ketorolac use prior to the administration of propofol-lignocaine regimen in elective laparoscopic surgery patients
Methods: It was a single blinded, randomized controlled trial, conducted at the department of Anesthesiology of a tertiary care hospital. One hundred twenty [I20] patients of either sex, 18 to 50 years of ages, and ASA class I or II scheduled for elective laparoscopic surgery were included in the study. Two groups were formed having sixty [60] patients in each group; group-A treated with ketorolac followed by propofol-lignocaine mixture while group-B treated with propofollignocaine mixture only. Pain was measured by asking patient to grade a score of pain on visual analogue scale [0-10cm]. Mean +/- SD expressed for continuous variable while categorical variables were expressed in frequency and percentages. Chi-square test was applied to test hypothesis with a p value of <0.05 significant
Results: The mean age in group-A was 33.33 +/- 12.08 years and 33.93 +/- 12.31 years in group-B. In group-A and group-B, the mean VAS score was 2.47 +/- 1.59 and 4.90 +/- 2.42 respectively. The frequency of pain was 20% [n=12] in group-A while in group-B it was 60% [n=36] with p value <0.0001. Patients pretreated with ketorolac had a significantly less incidence of pain [1.7% vs 25%; P value <0.0001] as compared to patients treated with propofol-lignocaine mixture only. Age and gender of patients were associated with more pain in propofol-lignocaine mixture only group compared with ketorolac pretreated group. Conclusion: The frequency and severity of pain was very low if the patients are treated with ketorolac before administration of propofol with lidocaine mixture
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 and 8-10 as severe pain]. If score was more than 3 a top up dose of lnj. 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 lnj. Ketorolac pre-emptively, therefore Ketorolac has little or no place as a preemptive analgesic