Pre-emptive intravenous paracetamol vs. ketorolac for shoulder pain in cesarean section under spinal anesthesia: A randomized double-blind placebo-controlled trial

Abstract

Introduction: Intraoperative shoulder pain (ISP) is a common side-effect of spinal anesthesia (SA) for cesarean sections (CS), but in most cases, it does not receive sufficient attention by the anesthesiologists. Following a randomized prospective double-blinded design, we aimed to compare the effect of ketorolac and paracetamol in prevention of the development and intensity of intraoperative ISP in patients undergoing CS under SA. \nMethodology: A total of 147 parturients, American Society of Anesthesiologists\xa0(ASA) Physical status II, who were planned for elective CS under SA were randomly allocated to three groups, to receive either intravenous ketorolac 30 mg (K group, n= 50), paracetamol 1 g (P group n= 50) or normal saline (Control group, n-52). Demographic data, surgery, negative outcomes, and average severity of ISP were collected by a blinded observer. Intraoperative ISP and intensity of intraoperative and postoperative ISP were defined as primary and secondary outcomes, respectively. Hypotension, bradycardia, and request for intraoperative rescue analgesia were other secondary outcomes. \nResults: The prevalence of ISP was significantly higher in the control group than in the other two groups (33.3% vs. 14% and 6.1 %, respectively, p = 0.002). The intensity of the pain was higher in the control group. (p = 0.748), and the parturients in the control group had a considerably higher demand for intraoperative analgesia (12.2 % vs. 0 % and 2 %, p < 0.001). We found no significant difference regarding incidences of bradycardia and hypotension between the groups (p = 0.99, p = 0.854). \nConclusion: Single shot ketorolac 30 mg and paracetamol 1 g may decline both development and intensity of intraoperative shoulder pain in C-sections under spinal anesthesia without enhancing negative events. \nKey words: Ketorolac; Acetaminophen; Shoulder pain; Cesarean section \nAbbreviations: ISP – intraoperative shoulder pain; CSI – combined spinal epidural anesthesia; SA – spinal anesthesia; CS – cesarean sections; NSAID – nonsteroidal anti-inflammatory analgesic; NRS – Numerical Rating Scale \nCitation: Dehghanpisheh L, Azemati S, Feiz F, Karami MY. Pre-emptive intravenous paracetamol vs. ketorolac for shoulder pain in cesarean section under spinal anesthesia: A randomized double-blind placebo-controlled trial. Anaesth. pain intensive care 2021;25(3):359–366. DOI: doi.org/10.35975/apic.v25i3.1425 \nReceived: January 15, 2021, Reviewed: January 17, 24, 2021, Accepted: February 19, 2021