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Ketorolac 15 mg versus 30 mg for Analgesia Following Cesarean Delivery
Abstract Number: S2B-3
Abstract Type: Original Research
Ketorolac is a nonsteroidal anti-inflammatory drug widely used as an adjunct for pain control following cesarean delivery. The lowest effective dose of ketorolac that achieves maximum analgesia without increasing side effects is unclear. The dose of ketorolac recommended by the manufacturer is 30 mg for adults < 65 years of age. A lower dose of 15 mg is sometimes used, but there are no data comparing the analgesic efficacy of lower versus higher doses in women undergoing cesarean delivery under neuraxial anesthesia. Since both 15 and 30 mg doses are used in our practice as part of a standardized protocol, we performed this study to compare the analgesic efficacy of both doses in our obstetric patient population.
Following IRB approval, a retrospective analysis was performed of patients who received either 15 mg or 30 mg of ketorolac during cesarean delivery from 07/01/2014 to 08/22/2017. In January 2016, we implemented a postoperative analgesic regimen where patients received a standardized dose of spinal (150 mcg) or epidural (3 mg) morphine. Intraoperatively, patients were given 975 mg of PR acetaminophen at the start of the case, and 15-30 mg of IV ketorolac intraoperatively within 15 minutes of the end of the case based on clinician preference. Postoperatively, patients were placed on scheduled PO acetaminophen (650 q6h) and ketorolac (15 mg q6h) for 3 doses then transitioned to PO ibuprofen (600 mg q6h). Oxycodone 5-10 mg, IV fentanyl or hydromorphone were given for breakthrough pain as needed. Primary outcome was need for supplementary opioids. Secondary outcomes were opioid consumption, pain scores, postoperative creatinine and need for rescue antiemetics.
A total of 1351 patients were included in the analysis. There was no difference in patient demographics or intraoperative characteristics between the two ketorolac dose groups. There was no significant difference between the groups in need for rescue opioids or total opioid consumption at 2, 24 and 48 hours (Table). There was also no difference between the groups in maximum pain scores, postoperative creatinine or need for rescue antiemetics (Table).
A 15 mg dose of ketorolac given intraoperatively for postoperative analgesia following cesarean delivery is non-inferior to a 30 mg dose.