Adjunctive use of Ketorolac for Postoperative Pain Management in Elective Cardiac Surgery Patients: A Randomized Control Trial

• Published in: Pakistan Armed Forces medical journal Vol. 72; no. SUPPL-3; pp. S585 - 90
• Main Authors: Muzaffar, Maaida, Khuwaja, Amin M., Ahmed, Aftab, Iqtdar, Rabia, Chohan, Haris Tariq, Siddiqi, Rashad
• Format: Journal Article
• Language: English
• Published: Rawalpindi Knowledge Bylanes 31.10.2022; AsiaNet Pakistan (Pvt) Ltd; Army Medical College Rawalpindi
• Subjects: Acetaminophen; Analgesia; Assaults; Bones; Cardiac patients; Care and treatment; Coronary artery bypass; Coronary artery bypass grafting; Coronary artery disease; Coronary heart disease; Fractures; Hospital patients; Intervention; Ketorolac; Males; Nalbuphine; Nonsteroidal anti-inflammatory drugs; Pain; Pain management; Pain, Postoperative; Paracetamol; Patients; Postoperative pain; Postoperative period; Sports injuries; Surgical site infections; Traffic; Trauma
• ISSN: 0030-9648; 2411-8842
• DOI: 10.51253/pafmj.v72iSUPPL-3.9559

Objective: To compare between the efficacy of Ketorolac and Paracetamol in the management of post-operative pain following elective cardiac surgery. Study Design: Randomized (single-blind) Control Trial (RCT NCT05361824.) Place and Duration of Study: This study was conducted in the Surgical Intensive Care Unit (SICU) at the National Institute of Cardiovascular Diseases Hospital, Karachi Pakistan, From 1st Jan to 30th Jun 2021. Methodology: Randomization of 60 patients undergoing elective cardiac surgery into either Paracetamol (30 control patients) or Ketorolac (30 treatment patients) was done.In addition, to a low dose, short duration background infusion of Nalbuphine, the control group was administered. Injection Paracetamol 1gm every six-hours. Whereas the treatment group was administered injection Ketorolac 30mg every eight-hours. Assessment of pain was done at 6, 12, 18 and 24 hours post-extubation, using a Visual analog scale (VAS). For the purpose of this study, a score of 4 or less was taken as a cut-off for adequate pain control. Results: VAS score was significantly lower in Ketorolac group as compared to the Paracetamol group at all four-time points with an average rating of 3.2±1.9 vs. 5.3±1.7; p<0.001, 3.5±1.5 vs. 5±1.7; p<0.001, 3.3±1 vs. 5.0±1.4; p<0.001, and 3.0±1.4 vs. 4.3±1.6; p<0.001 at 6, 12, 18, and 24 hours respectively. The total dose of Nalbuphine administered (infusion + bolus doses) over 48 hours post-operatively was 15.3±5.2 vs 25.7±6.8 ml; p<0.001 in the Ketorolac and Paracetamol groups, respectively. Conclusion: The use of Ketorolac in conjunction with Nalbuphine gives better control over post-operative pain in elective cardiac surgeries than Paracetamol and Nalbuphine.