///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

Ketorolac usage post-cesarean and effects on length of hospitalization and pain scores

Abstract Number: 76
Abstract Type: Original Research

Eric Hunt M.D., Ph.D.1 ; Connie Widdowson M.S., D.O.2; Linh T. Hoang M.D.3

Abstract

Background:

There is currently no standard of practice with regards to pain management after a cesarean section. As the rate of cesarean sections surpass 30% nationally, it becomes increasingly important to effectively manage post-cesarean pain levels. Typical treatments may include oral pain medication; these may be ineffective at completely controlling pain levels immediately post-operatively. Alternatively intravenous ketorolac may be administered, although its use is limited due to perceived risk of hemorrhage or additional blood loss.

Objective

The purpose of this study was to evaluate whether intravenous ketorolac (IV) administration decreased the length of hospitalization stay (LOS), impacted blood loss, improved patients pain scores, and resulted in earlier ambulation for postoperative cesarean section patients.

Methods

This was a retrospective observational cohort data study. The study population was randomly selected from cesarean section patients at Kaiser Permanente Oakland from January 2007 through 2008 who were administered ketorolac postoperatively compared to women who did not. The primary outcome of interest was length of maternal hospitalization. Secondary outcomes included estimated blood loss, pain scores, and evidence of early ambulation. A total of 200 subjects, 100 in each arm, were determined to have sufficient power of 80% in order to see a 24-hour difference in length of stay. Chi squared analysis for bivariate differences and two sample t-tests were used for continuous variables.

Results

There was no significant difference in length of hospital stay (LOS) 3.37 days versus 3.27 (p=0.98) days for ketorolac patients and non-ketorolac patients respectively. Estimated blood loss also showed no statistical significance with 807 ml in the ketorolac patients vs. 839 ml in the non-ketorolac patients (p= 0.24). Pain scores did not differ either with an average reported pain score of 3.19 vs. 3.40 for ketorolac vs. nonketorolac patients respectively (p= 0.58). Finally, the effects of ketorolac on ambulation demonstrated that 90.9% of ketorolac vs. 89.6% of non-ketorolac patients ambulated within the first 24-hours (p=1.00).

Conclusion

No statistically significant reduction in duration of hospital stay, estimated blood loss, pain scores, or ambulation was found when using IV ketorolac for postoperative cesarean section patients. While ketorolac may not show a significant reduction in LOS there was no significant increase in blood loss. Although this study failed to reveal any benefit from IV ketorolac, patients did not experience increase bleeding. Our future research will focus on the effect of ketorolac on broader post cesarean patient population.

SOAP 2010