Postoperative Analgesic Efficacy of Intravenous Ketorolac Compared with Placebo Following Spinal Anesthesia
DOI:
https://doi.org/10.61581/mjsp.v7i03.390Keywords:
Ketorolac, Spinal anesthesia, Randomized controlled trial, Pain, PlaceboAbstract
Objective: To compare postoperative pain, rescue analgesic requirements, comfort, and adverse events between intravenous ketorolac and placebo after elective surgery under spinal anesthesia.
Methods: This randomized placebo-controlled trial conducted at DHQ Hospital Lodhran form December 2025 to May 2026. Study included 50 adults aged 18–45 years with American Society of Anesthesiologists physical status I–II. Patients received a single intravenous ketorolac dose or normal saline, with 25 patients in each group. Pain was assessed at 2, 8, 12, and 24 hours. Intravenous paracetamol was available as rescue analgesia. Between-group differences were reported with 95% confidence intervals.
Results: At eight hours, mean pain scores were 3.29±0.83 with ketorolac and 4.70±1.03 with placebo, giving a mean difference of ?1.42 points (95% CI: ?1.95 to ?0.88; p<0.001). Rescue analgesia was required by 12 patients (48.0%) receiving ketorolac and 21 (84.0%) receiving placebo (p=0.016). The groups received 17 and 40 rescue doses, respectively. Pain scores did not differ significantly at 24 hours. Comfortable or very comfortable responses were reported by 80.0% and 48.0%, respectively.
Conclusion: Ketorolac was associated with lower early postoperative pain, reduced paracetamol rescue use, and greater comfort. Pain scores did not differ significantly at 24 hours, and safety conclusions remained limited.
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References
1. Walton LL, Duff E, Arora RC, McMillan DE. Surgery patients’ perspectives of their role in postoperative pain: a scoping review. Int J Nurs Stud Adv. 2023;5:100124.
2. Hyland SJ, Brockhaus KK, Vincent WR, Spence NZ, Lucki MM, Howkins MJ, et al. Perioperative pain management and opioid stewardship: a practical guide. Healthcare (Basel). 2021;9(3):333.
3. Joshi GP. Rational multimodal analgesia for perioperative pain management. Curr Pain Headache Rep. 2023;27(8):227–237.
4. Kianian S, Bansal J, Lee C, Zhang K, Bergese SD. Perioperative multimodal analgesia: a review of efficacy and safety of the treatment options. AnesthesiolPerioper Sci. 2024;2:9.
5. Deshler BJ, Rockenbach E, Patel T, Monahan BV, Poggio JL. Current update on multimodal analgesia and nonopiate surgical pain management. CurrProbl Surg. 2023;60(6):101332.
6. Chen Q, Chen E, Qian X. A narrative review on perioperative pain management strategies in enhanced recovery pathways—the past, present and future. J Clin Med. 2021;10(12):2568.
7. Baamer RM, Iqbal A, Lobo DN, Knaggs RD, Levy NA, Toh LS. Utility of unidimensional and functional pain assessment tools in adult postoperative patients: a systematic review. Br J Anaesth. 2022;128(5):874–888.
8. Halvey EJ, Haslam N, Mariano ER. Non-steroidal anti-inflammatory drugs in the perioperative period. BJA Educ. 2023;23(11):440–447.
9. Doleman B, Leonardi-Bee J, Heinink TP, Boyd-Carson H, Carrick L, Mandalia R, et al. Pre-emptive and preventive NSAIDs for postoperative pain in adults undergoing all types of surgery. Cochrane Database Syst Rev. 2021;6:CD012978.
10. McNicol ED, Ferguson MC, Schumann R. Single-dose intravenous ketorolac for acute postoperative pain in adults. Cochrane Database Syst Rev. 2021;5:CD013263.
11. Joseph JM, Gori D, Curtin C, Hah J, Ho VT, Asch SM, et al. Gaps in standardized postoperative pain management quality measures: a systematic review. Surgery. 2022;171(2):453–458.
12. National Library of Medicine. Ketorolac tromethamine injection, solution [Internet]. DailyMed [cited 2026 Sep 30].
13. National Library of Medicine. Acetaminophen injection, solution [Internet]. DailyMed [cited 2026 Sep 30].
14. Ahmed SM, Shabbir S, Rana NA, Khatoon A, Ghani UF, Basharat I, et al. Comparing the postoperative analgesic efficacy of ketorolac and tramadol after open inguinal hernia mesh repair: a randomized controlled trial. Cureus. 2024;16(10):e71363.
15. Amin S, Hasanin A, Attia OA, Mostafa M, Elzayat NS, Elsherbiny M, et al. Intravenous ibuprofen versus ketorolac for perioperative pain control in open abdominal hysterectomy: a randomized controlled trial. BMC Anesthesiol. 2024;24:202.
16. Guan J, Feng N, Yang K, Abudouaini H, Liu P. The efficacy and safety of ketorolac for postoperative pain management in lumbar spine surgery: a meta-analysis of randomized controlled trials. Syst Rev. 2024;13:275.
17. Sivasundaram L, Mengers S, Trivedi NN, Strony J, Salata MJ, Voos JE, et al. Oral ketorolac as an adjuvant agent for postoperative pain control after arthroscopic rotator cuff repair: a prospective, randomized, controlled study. J Am AcadOrthop Surg. 2021;29(24):e1407–e1416.
18. Auwattanamongkol T, Laohaprasitiporn P, Monteerarat Y, Limthongthang R, Vathana T. Local ketorolac infiltration for postoperative pain in open trigger finger surgery: a randomized controlled trial. BMC MusculoskeletDisord. 2024;25:746.
19. Salehi Aliabad M, Sheybani S, Mehrad-Majd H, Sharifian Attar A. Comparison of analgesic effects of ketorolac plus Apotel to meperidine in patients undergoing right thoracotomy: a double-blind randomized clinical trial. Anesth Pain Med. 2023;13(4):e136822.
20. Pakniyat S, Mousavi G, Jarineshin H, Fekrat F, Sabet N, Abdullahzadeh-Baghaei A. Comparison of the preemptive/preventive effect of dexmedetomidine and ketorolac on post-operative pain of appendectomy patients: a randomized clinical trial. Anesth Pain Med. 2024;14(6):e146868.
21. Bongiovanni T, Lancaster E, Ledesma Y, Whitaker E, Steinman MA, Allen IE, et al. Systematic review and meta-analysis of the association between non-steroidal anti-inflammatory drugs and operative bleeding in the perioperative period. J Am Coll Surg. 2021;232(5):765–790.e1.
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Copyright (c) 2026 Muhammad Ferhan Saeed, Farah Ahmad, Syed Hassan Danish, Muhammad Ali Khawaja, Syeda Ayesha Imtiaz Bukhari, Furqan Arshad
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