The Use of Levobupivacaine With or Without Ketorolac in Post Cesarean Pain Management: A Randomized Double-blinded Control Trial
Wongsree R, MD1, Suwannarurk K, MD1, Pongrojpaw D, MD1, Chanthasenanont A, MD1, Singwongsa A, MD1, Pattaraarchachai J, PhD2, Bhamarapravatana K, PhD3
Affiliation : 1 Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand 2 Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand 3 Department of Preclinical Sciences, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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 post-
surgery. 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
