Postpartum opioid use lower with more doses of ketorolac after cesarean delivery

Administering six vs. two doses of ketorolac for pain management after cesarean delivery was associated with fewer opioid orders within 72 hours postpartum, according to a presenter at The Pregnancy Meeting.

“The use of NSAIDs after cesarean delivery decreases patient pain scores and opioid exposure, but the optimal agent, dose and administration timing of NSAID has not been determined,” Jean C. Hostage, MD, a maternal-fetal medicine fellow at Tufts Medical Center in Boston, said during the presentation. “Our objective was to study whether a protocol of scheduled ketorolac administration after cesarean delivery would decrease postoperative opioid use.”

Hostage and colleagues conducted a randomized, double-blind trial among patients at their institution who underwent cesarean delivery with neuraxial anesthesia between May 2019 and January 2022. The 148 participants received two doses of IV ketorolac 30 mg, then were randomly assigned 1:1 to four more doses of ketorolac or placebo every 6 hours.

When needed, participants were given acetaminophen and opioids measured as morphine milligram equivalents (MME).

Participants in the prolonged ketorolac group had a lower MME within 72 hours post-cesarean compared with the placebo group (median, 30 vs. 60; P = .0001). The ketorolac group was more likely to have no opioid use during that time period vs. the placebo group (32% vs. 12%; P = .003).

Ketorolac participants were less likely to have pain scores above 3 out of 10 (P = .0005).

There were no significant differences between groups in hematocrit levels on the first day postpartum or creatinine levels on postoperative day 2.

Participants reported similar satisfaction with inpatient pain management and postoperative care, according to the presentation.

“Our study showed that scheduled intravenous ketorolac administration decreased post-cesarean opioid use without adverse effects,” Hostage said.