A comparison between ketorolac and diclofenac in laparoscopic sterilization

Abstract

We compared ketorolac and diclofenac for the prevention and treatment of post-operative pain in patients undergoing laparoscopic sterilization. Fifty ASA I or II women were allocated randomly to receive either diclofenac 75 mg or ketorolac 30 mg intramuscularly 30-90 min before general anaesthesia. Pain scores were assessed half-hourly in the recovery room and then at 2 h and 4 h in the ward. In the recovery room, pain was treated with a second dose of the study drug, followed by parenteral pethidine if necessary. Four patients in the diclofenac group and five patients in the ketorolac group requested no analgesics after surgery. Fifteen patients from each group had satisfactory analgesia after the second dose of study drug. Pain scores were similar between groups at all times. The median (range) initial pain score in the recovery room was 5 (0-9.5) in the diclofenac group and 5 (1-9) in the ketorolac group. Pain at the injection site was more common after diclofenac than ketorolac (12 vs. 3, P < 0.05). In conclusion, both intramuscular diclofenac and ketorolac were relatively ineffective in controlling the pain after laparoscopic sterilization. The drugs were equally well tolerated, but more patients complained of pain at the injection site after diclofenac.

PIP: A comparison of two non-steroidal anti-inflammatory drugs (NSAIDs), ketorolac and diclofenac, indicates both were relatively ineffective for treating pain after laparoscopic sterilization. NSAIDs produce analgesia by inhibiting the synthesis of prostaglandins. Patients were randomly assigned to receive intramuscular injections of either 75 mg of diclofenac (n = 25) or 30 mg of ketorolac (n = 25) 30-90 minutes before surgery. There were no major anesthesia or surgical complications. The median duration of surgery, time from initial dose of NSAID to arrival in the recovery room, and length of stay in the recovery room were 20, 75, and 60 minutes, respectively, in both groups. Only 4 women in the diclofenac group and 5 in the ketorolac group did not require further analgesia after surgery, but 60% had adequate analgesia after a second NSAID dose. Pain scores, postoperative nausea and vomiting, and the requirement for anti-emetics did not differ between groups. Injection site pain lasted 15-30 minutes after ketorolac compared with 8-12 hours after diclofenac. While the analgesic potency of ketorolac is about 5 times that of diclofenac, the anti-inflammatory potency of ketorolac is only twice that of diclofenac.