Objectives: ketorolac may attenuate maternal stress response to tracheal intubation, without subsequent dangers of opioid-induced neonatal depression. The objective of this study is to evaluate the haemodynamic and hormonal effects of pre-emptive ketorolac on surgical stress and the postoperative analgesic consumption, after Cacsarean delivery. Study Design: A prospective randomized double-blinded placebo-controlled study.
Methods: After ethical approval, 90 patients scheduled for elective Cacsarean deliveries were randomly allocated U) the ketorolac group (/*=45); received IV ketorolac 15 mg bolus, followed by an infusion of 7.5 mg.lr'.and the saline for placebo group (/;=45). Anaesthesia was maintained with 50% nitrous oxide, 0.5% isoflurane, and vecuronium. The haemodynamic variables and the levels of plasma corlisol were recorded before and after induction, and after delivery, The graded uterine relaxation, the need for supplementary doses of oxylocin, the peri-operative blood loss, bleeding lime, and Apgar scores at 1 and 5 minutes, postoperative pain scores at rest and with movement, and namadol consumptions were assessed.
Results: After intubation, parturients receiving ketorolac had a smaller increase in heart rale, systolic and mean arterial blood pressure (P< 0.001) and lower plasma corlisol concentrations, (45± 15.1 vs. 32.2 ± 7.61 Ug. dl"', P<0.05). Therefore, they had lower VAS pain scores al rest and on movement, for the first 2 postoperative hours (P<0.001), later lime to first request for analgesia and less iramadol consumption for the first 4 post-operative hours [0 (0-100) mg vs. 100 (0-100) mg, P = 0.004]. There were no differences between groups with regard to peri-operative blood loss, bleeding lime, transfusion requirements, nausea, vomiting or Apgar scores, with no evidence of premature closure of the ductus arteriosus of the newborns.
Conclusion: Pre-emptive ketorolac is safe and effective in attenuating the maternal stress response with improved quality of post-operative analgesia in Caesarean delivery patients.