Comparison of Two Dosing Regimens of Intravenous Ketorolac for Post-Cesarean Pain Control

Comparison of Two Dosing Regimens of Intravenous Ketorolac for Post-Cesarean Pain Control: A Randomized Controlled Trial

we aim to compare the analgesic efficacy of two intravenous ketorolac dosing regimens as part of a multimodal analgesic protocol that includes local wound infiltration for postoperative pain management after elective cesarean delivery.

Spinal anesthesia will be achieved by injecting 10 mg hyperbaric bupivacaine 0.5% plus 25 mcg fentanyl Prophylactic vasopressor will be administered in all patients, Following delivery, all patients will receive a single dose of dexamethasone (8 mg) along with the first dose of intravenous ketorolac. Subsequent ketorolac doses will be administered every 8 hours.

After closing the fascia, the subcutaneous layer will be infiltrated with 30 mL of 0.25% bupivacaine.

Postoperatively, if the Numeric rating scale is > 3, intravenous nalbuphine 0.1 mg/kg titrated to response, with maximum single dose of 20 mg and maximum daily dose of 160 mg.

Inclusion Criteria:

• full-term, singleton, pregnant women,
• aged 18-35 years,
• scheduled for elective cesarean delivery under spinal anesthesia

Exclusion Criteria:

• American Society of Anesthesiologists (ASA) physical class III or more
• multiple gestation. Patients with a history of allergy to any of the study drugs,
• renal impairment,
• gastrointestinal bleeding or ulceration
• inflammatory bowel disease,
• chronic pain or regular opioid use.
• Inability to comprehend the numeric pain scale (NRS) or the ObsQoR-11 score
• requirement for conversion to general anesthesia after spinal anesthesia