COMPARISON OF ANALGESIC EFFICACY BETWEEN INTRAVENOUS PATIENT-CONTROLLED NEFOPAM AND KETOROLAC IN POST-CESAREAN SECTION PATIENTS AT HANOI OBSTETRICS AND GYNECOLOGY HOSPITAL FROM 2024 TO 2025

Truong Ba Tu1, Nguyen Duc Lam2, Tran Van Cuong2
1 Chuong My General Hospital
2 Hanoi Obstetrics and Gynecology Hospital

Main Article Content

Abstract

Objective: To compare the analgesic efficacy of Nefopam and Ketorolac administered via patient-controlled intravenous analgesia after cesarean section at Hanoi Obstetrics and Gynecology Hospital during 2024-2025.


Subjects and methods: A controlled clinical intervention was conducted on 60 parturients who underwent cesarean section under spinal anesthesia at Hanoi Obstetrics and Gynecology Hospital from September 2024 to June 2025.


Results: The two study groups were homogeneous in clinical characteristics. The analgesic efficacy of Nefopam and Ketorolac was found to be equivalent at all evaluated time points, with mean VAS scores maintained at a mild pain level (≤ 2 points) after 24 hours. The total patient-controlled intravenous analgesia dose consumed after 48 hours showed no statistically significant difference between the two groups (Nefopam group 105.16 ± 46.75 mg vs. Ketorolac group 106.83 ± 45.98 mg, p ≈ 0.52). Patient satisfaction rates were also comparable (76.7% in the Nefopam group vs. 80.0% in the Ketorolac group, p = 1.000).


Conclusion: The use of Nefopam and Ketorolac alone in patient-controlled intravenous analgesia provides equivalent postoperative analgesic efficacy after cesarean section, achieves high patient satisfaction, and eliminates the need for Morphine rescue.

Article Details

References

[1] International Association for the Study of Pain
(IASP). IASP announces revised definition of pain.
Accessed May 21, 2024. https://www.iasp-pain.
org/publications/iasp-news/iasp-announces-revised-definition-of-pain/
[2] Lutz L.J, Lamer T.J. Management of postoperative
pain: Review of current techniques and methods.
Mayo Clin Proc, 1990, 65 (4): 584-596. https://doi.
org/10.1016/s0025-6196(12)60957-4.
[3] Rem J, Brandt M.R, Kehlet H. Prevention of postoperative lymphopenia and granulocytosis by epidural analgesia. Lancet Lond Engl, 1980, 1 (8163): 283-284. https://doi.org/10.3390/healthcare8010041.
[4] Takegata M, Smith C, Nguyen H.A.T et al. Reasons for increased caesarean section rate in Vietnam: A qualitative study among Vietnamese mothers and health care professionals. Healthcare, 2020, 8 (1): 41. https://doi.org/10.1097/aln.0b013e31828866b3.
[5] Gerbershagen H.J, Aduckathil S, van Wijck A.J.M,
Peelen L.M, Kalkman C.J, Meissner W. Pain intensity on the first day after surgery: A prospective cohort study comparing 179 surgical procedures. Anesthesiology, 2013, 118 (4): 934-944. https://doi.org/10.1097/aln.0b013e31828866b3.
[6] Wheatley R.G, Schug S.A, Watson D. Safety and efficacy of postoperative epidural analgesia. Br J Anaesth, 2001, 87 (1): 47-61. https://doi.org/10.1093/bja/87.1.47.
[7] Parnass S.M, Schmidt K.J. Adverse effects of spinal and epidural anaesthesia. Drug Saf, 1990, 5(3): 179-194. https://doi.org/10.2165/00002018-199005030-00003.
[8] Yurashevich M, Pedro C, Fuller M, Habib A.S. Intra-operative Ketorolac 15 mg versus 30 mg for
analgesia following cesarean delivery: A retrospective study. Int J Obstet Anesth, 2020, 44: 116-121. https://doi.org/10.1016/j.ijoa.2020.08.009.
[9] Hwang B.Y, Kwon J.Y, Lee D.W, Kim E, Kim T.K, Kim
H.K. A randomized clinical trial of Nefopam versus Ketorolac combined with Oxycodone in patient-controlled analgesia after gynecologic surgery. Int J Med Sci, 2015, 12 (8): 644-649. 10.7150/ijms.11828.
[10] Son J.S, Doo A, Kwon Y.J, Han Y.J, Ko S. A comparison between Ketorolac and Nefopam as adjuvant analgesics for postoperative patient-controlled analgesia: a randomized, double-blind, prospective study. Korean J Anesthesiol, 2017, 70 (6): 612-618. https://doi.org/10.4097/kjae.2017.70.6.612.