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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

A Randomized Control Trial of Ketorolac versus Placebo for Post-Cesarean Delivery Pain: Decreased Opioid Use with No Effect on Estimated Blood Loss.

Abstract Number: T5A-6
Abstract Type: Original Research

John J. Kowalczyk M.D.1 ; Sherry Y. Tang B.Sc.2; David Sheyn M.D.3; David Hackney M.D.4; Evan Goodman M.D.5

Introduction:

Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) that decreases opioid-use for post-surgical patients (1,2). Prior studies have shown NSAIDs may cause platelet dysfunction, uterine atony and hypertension, limiting their use in cesarean delivery. Prospective studies in other surgical specialties have shown intraoperative ketorolac does not increase estimated blood loss (EBL) (3). In this prospective, double-blind randomized control trial, we examined the effect of ketorolac versus placebo on post-cesarean delivery opioid consumption and EBL.

Methods:

Women undergoing cesarean delivery with combined spinal epidural anesthesia who met inclusion criteria were approached for informed consent. Patients were then randomized to receive 3.5 mg epidural morphine plus either intravenous 30 mg ketorolac or placebo immediately after delivery and cord clamp. Randomization was performed by the investigational pharmacy to ensure blinding. A priori power analysis determined 58 patients were needed to detect a difference in both opioid consumption and EBL. Independent-samples t-test and Mann-Whitney U test were used to compare demographics and outcomes, as appropriate. Our primary outcome was the total hydromorphone dose in the 24 hours post-cesarean. A number of secondary outcomes were evaluated including EBL and change in blood pressure compared to baseline.

Results:

We enrolled 69 patients; 58 remained after predetermined exclusion criteria. The median [interquartile range] dose of hydromorphone was significantly less in patients who received ketorolac; placebo=0.2 mg [0-0.6], ketorolac=0.0 mg [0-0.2], (p=0.039) (Fig 1a). EBL of patients who received ketorolac was not statistically different from patients who received epidural morphine alone; placebo=800 ml [400-1200], ketorolac=900 ml [545-1255], (p=0.259) (Fig 1b). There was no difference in the change in blood pressure compared to baseline, except a decrease in systolic blood pressure at 12 hours in the ketorolac group, placebo= -2.9% [-21.1 - +14.3], ketorolac= -8.1% [-19.2 - -3.0], (p=0.035).

Conclusions:

The use of epidural morphine plus ketorolac reduces post-cesarean delivery opioid requirement when compared to epidural morphine alone. In addition, ketorolac does not increase EBL or blood pressure compared to baseline.

References:

1. Pavy TJ. Anesth Analg. 2001 Apr: 1010-4.

2. Lowder JL. Am J Obstet Gynecol. 2003 Dec: 1559-62.

3. Gobble RM. Plast Reconstr Surg. 2015 Jan 29: 741-755.



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