Background: Cesarean delivery is the most common operative procedure among women of reproductive age. Post-cesarean pain is chief among the major problems in parturients. An effective analgesia is required for adequate postoperative pain management.
Objective: To determine the effectiveness in postoperative pain reduction of levobupivacaine usage compared to its combination
with ketorolac via local infiltration postoperatively in participants who underwent cesarean delivery under spinal anesthesia.
Materials and Methods: Pregnant women between 18 and 40 years of age who underwent cesarean delivery at Thammasat University Hospital were enrolled. The participants were randomly allocated into two groups; the study and control groups received local surgical wound infiltration of 50 mg of levobupivacaine (0.5%) with or without 30 mg of ketorolac at the end of surgical wound closure, respectively. After the operation, the visual analog scale (VAS) was recorded at 1, 2, 4, 8, 12, 18 and 24 hours. Demographic data, additional opioid requirements in the first 24 hours postoperative and adverse effects were also recorded.
Results: A total of 160 parturients were recruited, consisting of 80 cases in each group. Both groups were comparable in demographic data. Mean postoperative pain in the study group was significantly lower than the control group within the first 24 hours postsurgery. Overall meperidine requirement during the first 24 hours and adverse side effects in the study and control groups were comparable.
Conclusion: Combined ketorolac with levobupivacaine significantly decreased post-cesarean pain in the first 24 hours compared to the use of only levobupivacaine.

Keywords: Ketorolac, Levobupivacaine, Cesarean delivery, Pain