COMPARISON OF ANALGESIC EFFICACY OF INTRATHECAL KETOROLAC, MORPHINE AND ITS COMBINATION AS AN ADJUVANT TO BUPIVACAINE FOR LOWER LIMB SURGERIES- A PROSPECTIVE RANDOMISED STUDY
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 2
Abstract
BACKGROUND Ketorolac is a non-steroidal anti-inflammatory agent with strong analgesic activity, when added as an adjuvant to intrathecal bupivacaine acts on the COX receptors at the spinal level and inhibits the synthesis of prostaglandins. Aims- To evaluate the analgesic efficacy of intrathecal ketorolac, morphine and its combination when added as an adjunct to bupivacaine and, onset of sensory and motor blockade, quality of analgesia, side effects of the adjuvants used intrathecally. MATERIALS AND METHODS A prospective, randomised, double blind, placebo controlled study was conducted on 100 adult patients undergoing elective lower limb orthopaedic and general surgeries. Patients were randomly allocated into 4 groups (n=25) by using computer generated random numbers. Each group received 15 mg (3 mL) of hyperbaric bupivacaine along with either 0.5 mL normal saline in group P, ketorolac 2 mg (0.5 mL) in group K, morphine 200 mcg (0.5 mL) in group M, and ketorolac-morphine combination 2 mg + 200 mcg (0.5 mL) in group KM. Statistical analysis of data was done by using statistical package for social science (SPSS) evaluation version 22. One way ANOVA, Kruskal-Wallis tests were used for multiple group comparison and categorical data analysed by chi-square test. RESULTS The mean visual analogue scale score in group P was 5.4 ± 1.8 and in groups M, K, KM were 5.3 ± 1.5, 5.1 ± 1.7, 5.3 ± 1.6 respectively. The duration of analgesia in group P was 136 ± 16 min. and in groups M, K, and KM were 695 ± 62 min., 590±56 min., and 1188±93 min respectively. The quality of analgesia was excellent at 92% in combination group compared to other groups. CONCLUSION Ketorolac-morphine combination as an adjunct to intrathecal bupivacaine provides prolonged post-operative analgesia compared to ketorolac or morphine alone that is up to 15 hours in lower limb surgeries with significant inflammation.
Authors and Affiliations
Syed Uwais Raza, Jyothi B, Pratishruti Pratishruti, Safiya Imtiaz Shaikh
Keywords
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- EP ID EP284542
- DOI 10.14260/jemds/2018/38
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