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

Abstract

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.