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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
125
administered intravenously as 30 mg diluted in 10 mL of normal saline and injected over more than 15 seconds
administered intravenously as either 15 mg diluted in 10 mL of normal saline and injected over more than 15 seconds.
Kasr Alainy Hospital
Cairo, Egypt
numeric rating scale at rest
the patient rates their pain on a scale of 0 to 10, with 0 being "no pain" and 10 being the "worst pain imaginable"
Time frame: 6 hours postoperatively
numeric rating scale at rest
person rates their pain on a scale of 0 to 10, with 0 being "no pain" and 10 being the "worst pain imaginable"
Time frame: at 30 minutes, 12-, 18-, and 24 hours postoperatively
numeric rating scale during movement
person rates their pain on a scale of 0 to 10, with 0 being "no pain" and 10 being the "worst pain imaginable" during change position from supine to sitting or ambulation
Time frame: at 30 minutes, 6-, 12-, 18-, and 24 hours postoperatively
total nalbuphine consumption
mg
Time frame: from 0.5 hour postoperatively to 24 hour postoperatively
time to first analgesic requirement
hours
Time frame: time from immediately postoperatively to time of first analgesic requirement during the first 24 hours
ObsQoR-11 score
The ObsQoR-11 is an 11-item questionnaire to assess a patient's recovery after a C-section, with a total score ranging from 0 to 100, where 100 is the best possible recovery
Time frame: 24 hour postoperatively
patient's satisfaction
At the end of the study the patient will be asked to rate her satisfaction with pain control using the NRS 10= strongly unsatisfied, 0= strongly satisfied
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Time frame: 24 hour postoperatively