Postoperative Analgesic Efficacy of Intravenous Ketorolac Compared with Placebo Following Spinal Anesthesia

Abstract

Objective:  To compare postoperative pain, rescue analgesic requirements, comfort, and adverse events between intravenous ketorolac and placebo after elective surgery under spinal anesthesia. Methods: This randomized placebo-controlled trial conducted at DHQ Hospital Lodhran form December 2025 to May 2026. Study included 50 adults aged 18–45 years with American Society of Anesthesiologists physical status I–II. Patients received a single intravenous ketorolac dose or normal saline, with 25 patients in each group. Pain was assessed at 2, 8, 12, and 24 hours. Intravenous paracetamol was available as rescue analgesia. Between-group differences were reported with 95% confidence intervals. Results: At eight hours, mean pain scores were 3.29±0.83 with ketorolac and 4.70±1.03 with placebo, giving a mean difference of ?1.42 points (95% CI: ?1.95 to ?0.88; p<0.001). Rescue analgesia was required by 12 patients (48.0%) receiving ketorolac and 21 (84.0%) receiving placebo (p=0.016). The groups received 17 and 40 rescue doses, respectively. Pain scores did not differ significantly at 24 hours. Comfortable or very comfortable responses were reported by 80.0% and 48.0%, respectively. Conclusion: Ketorolac was associated with lower early postoperative pain, reduced paracetamol rescue use, and greater comfort. Pain scores did not differ significantly at 24 hours, and safety conclusions remained limited.