A Comparison of Incisional Infiltration of Ketorolac with or without Bupivacaine Versus intramuscular ketorolac for postoperative analgesia

Volume : VII, Issue : VIII, August - 2018

Dr. Irfan Rasool Bhat, Dr. Ved Prakash Pandey, Dr. Sachin Jain

Background: The use of non–steroidal anti–inflammatory drugs (NSAIDs) for post–operative analgesia has become popular in surgeries ranging

from minor outpatient procedures to major inpatient surgeries. In common with other NSAIDs, ketorolac has been advocated as an adjuvant to

reduce post–operative pain and opioid requirements. Ketorolac is a NSAID that acts through inhibition of prostaglandin synthesis and is said to

have analgesic efficacy comparable to morphine.

Aims: The study is aimed to assess and compare the effects of incisional infiltration of ketorolac with or without bupivacaine and intramuscular

ketorolac for post–operative analgesia.

Methods and Material: The study was a prospective, randomized, controlled, double blinded study. 60 patients undergoing elective lower

abdominal surgery were divided into three groups of 20 each. Group C (Control) received incisional infiltration with 20 ml normal saline and

intramuscular ketorolac 60 mg, Group K received incisional infiltration with 20 ml normal saline with 30mg ketorolac added to it, Group KB

received incisional infiltration with 20 ml of 0.25% bupivacaine with 30 mg ketorolac added to it.

Statistical analysis used: Microsoft Excel 2007 and statistical software plug–ins, Chi–square test and student t–test (Unpaired and One way

ANOVA).Data are being represented as mean � SD. A �p� value of <0.05 was considered significant.

Results: Pain score (mean VAS score) at 2 hours postoperatively was comparable in Group C (2.40+0.50), Group K (2.20+0.41), and Group KB

(2.10+0.31). Mean VAS scores at 4,6,12,24 hours respectively in postoperative period were significantly less in Group KB (2.12�0.35; 2.15�0.36;

2.85�0.74; 4.75�0.64 ), Group K (2.25+0.40; 2.40�0.50; 4.40�0.59; 5.50�0.51 ) as compared to Group C (3.25+0.85; 5.50�0.51; 6.35�0.489;

6.60�0.46). Duration of analgesia was significantly prolonged in Group KB (12.05�2.114 hours) as compared to Group K (6.8�0.834 hours) and

Group C (4.10�0.641 hours).

Conclusions: Addition of ketorolac to bupivacaine for incisional infiltration produces early onset, better quality of intraoperative as well post –

operative analgesia as compared to infiltration of ketorolac alone, while use of intramuscular ketorolac does not produce any significant difference

in postoperative analgesia.