Comparison of ketorolac with morphine for intra-operative analgesia in patients undergoing total abdominal hysterectomy

Abstract

Objective: To compare ketorolac 0.35 mg x kg(-1) with morphine 0.1 mg x kg(-1) for hemodynamic stability, efficacy of analgesia and incidence of side effects in patients undergoing elective total abdominal hysterectomy.

Methods: Fifty ASA I and II patients, were enrolled in a prospective, randomized and double blind study. They were divided in two equal groups. Group K received Inj. Ketorolac 0.35 mg x kg(-1) while group M received Inj. Morphine 0.1 mg x kg(-1) 5 minutes before induction of anaesthesia. Hemodynamic responses to laryngoscopy, endotracheal intubation, and surgical incision were noted.

Results: Data was entered and analysis was done using SPSS version 10.0. Student-t test and comparison of proportions were done where required. ANOVA was done and a p-value of <0.05 was considered statistically significant. There was a significant rise in heart rate, systolic, diastolic and mean arterial pressure in ketorolac group (K) as compared to baseline values at points of endotracheal intubation and surgical incision. Patients in Morphine group (M) showed a significant increase in heart rate only. There was no statistically significant difference between the two groups for supplemental analgesia requirement intraoperatively and postoperatively. Complications seen with group K were increased surgical wound bleeding in 2 patients (8%), nausea and vomiting in 4 patients (16%) while in group M there was nausea and vomiting in 5 patients (20%), and respiratory depression in 1 patient (4%).

Conclusion: Although hemodynamic stability at points of painful stimulation was lower in patients given ketorolac as compared to morphine, Ketorolac has a place in the intraoperative pain relief in Pakistan and other developing countries where availability of powerful narcotics is erratic.