A Randomized Controlled Trial of Intravenous and Intramuscular Ketorolac for Post-Cesarean Analgesia

Backgroundː Optimal analgesia post-cesarean delivery is essential to promote maternal recovery for the care of the newborn. Intravenous (IV) ketorolac is commonly administered as a part of multi-modal analgesia for cesarean delivery. Ketorolac pharmacokinetics is altered in pregnancy. The purpose of this study is to compare the efficacy of IV and intramuscular (IM) ketorolac for post-cesarean analgesia. Methodsː This study is a prospective, double blinded, randomized controlled trial to assess the efficacy of IV versus IM ketorolac administration on post-cesarean analgesia. Patients undergoing an elective cesarean delivery under spinal anesthesia were randomized to receive either 30 mg IV ketorolac (Group 30IV), 30 mg IM ketorolac (Group 30IM), or 60 mg IM ketorolac (Group 60IM). Primary outcomes include time to the first analgesic, total analgesic consumption, and pain scores. Secondary outcomes include patient satisfaction, opioid related side effects, and length of hospital stay. Resultsː The time to first break through pain was not statistically significant in the IM groups as compared to the IV group (Group 30IV 527 min, Group 30IM 578 min and Group 60IM 581 min). Pain scores and post-operative analgesic use did not differ significantly between groups. Secondary outcomes did not differ between groups. Conclusionsː IV and IM ketorolac are equally effective for post-cesarean analgesia.