Dr. Hostage’s presentation is entitled “Scheduled ketorolac administration after cesarean section and its effect on opioid use: a randomized control trial.” (Hostage J, Kolettis D, Sverdlov D, Ludgin J, Drzymalski D, Mhatre M, House M.) The abstract is below.
In recognition of the opioid crisis, efforts have been made to reduce opioid use for pain management following cesarean section by increasing NSAID use. There is data to support that ketorolac is a safe and effective analgesic for the postpartum patient. However, there is a paucity of literature that evaluates the effect of scheduled intravenous ketorolac on the amount of oral narcotic administered in the postpartum period.
To evaluate the efficacy of increased ketorolac to reduce opioid use after cesarean delivery.
This was a single-center, randomized, double-blind, parallel-group trial to assess pain management following cesarean section with ketorolac versus placebo. All patients undergoing cesarean section with regional anesthesia received two doses of 30mg IV ketorolac post-operatively per hospital protocol, and were then randomized to receive an additional four doses of 30 mg of IV ketorolac every 6 hours or four doses of placebo. The primary outcome was the amount of morphine milligram equivalents (MME) used in each group in the first 72 post-operative hours. Secondary outcomes included post-operative pain scores, post-operative change in hematocrit, and post-operative satisfaction with inpatient care. A sample size of 74 per group (n=148) was planned.
From May 2019 to January 2022, 245 women were screened and 148 patients were randomized: 74 in the ketorolac group and 74 in the placebo group. Patient demographics were comparable between groups. Additional ketorolac significantly decreased MME use after cesarean delivery (median 30.0, IQR 0.0, 67.5) compared to the placebo group (60.0, IQR 30.0, 112.5) (p=0.0001). In addition, patients who received placebo were more likely to have pain scores greater than 3 over time (p=0.0005). There was not a significant difference in the mean change in hematocrit at post-operative day (POD) 1 between the two study groups (P = 0.85). Patient satisfaction with post-operative care was similar between groups.
Additional ketorolac significantly decreased MME use after cesarean delivery. Patient-reported satisfaction with inpatient care was similar between groups.
Learn more about Dr. House’s research here