The effect of intravenous ketorolac on opioid requirement and pain after cesarean delivery

Nonsteroidal antiinflammatory drugs, including ketorolac, are widely used f or postoperative analgesia. This randomized, double-blinded trial compared TV ketorolac or saline combined with meperidine patient-controlled epidural analgesia (PCEA) after cesarean delivery. Fifty healthy parturients scheduled for elective cesarean delivery under co mbined spinal-epidural anesthesia received PCEA plus either TV ketorolac (G roup K) or saline (Group C) for 24 h. The ketorolac dose was modified, afte r six patients had been studied, based on new product information recommend ing a maximum of 120 mg ketorolac over 24 h. Group K (n = 24) and Group C (n = 20) were demographically similar. During the first 24 h, Group K used significantly less meperidine (P < 0.05). Post operative pain at rest and with movement, and patient satisfaction, did not differ significantly between groups, except that worst pain at 12 h was le ss in Group K (P < 0.005). The two groups were similar with respect to pati ent recovery and side effects. IV ketorolac, as an adjunct to PCEA after cesarean delivery, produced a mep eridine dose-sparing effect of approximately 30%, but did not significantly improve pain relief, reduce opioid-related side effects, or change patient outcome.