Pre-emptive ketorolac for prevention of intraoperative shoulder pain in patients undergoing cesarean section: A double blind randomized clinical trial

Background: Shoulder pain is a commonly observed but mostly neglected consequence of cesarean section and little is known as well as explored about intraoperative shoulder pain. We conducted this randomized prospective double-blinded study to evaluate the efficacy of ketorolac in reducing the incidence and severity of intraoperative shoulder pain in patients undergoing cesarean section. Methods: Two hundred ASA I and II patients scheduled to undergo elective cesarean section under spinal anesthesia were randomized to receive either intravenous ketorolac 30 mg (ketorolac group) or normal saline (control group). The primary outcome was the incidence of intraoperative shoulder pain. Secondary outcomes were severity of intraoperative shoulder pain, amount of intraoperative blood loss, incidence of hypotension, bradycardia and request for intraoperative rescue analgesia. Results: The incidence of intraoperative shoulder pain in the control group was significantly higher than the ketorolac group (P = 0.003). Severity of shoulder pain and requests for intraoperative analgesia was significantly higher in the control group (P = 0.012, P = 0.006 respectively). Patients in the Ketorolac group experienced significantly higher incidences of bradycardia (P = 0.037). Conclusion: 30 mg ketorolac administered intravenously just before the operation could decrease incidence and severity of intraoperative shoulder pain in patients undergoing cesarean section.