MORPHINE VS KETOROLAC

POST-OPERATIVE ANALGESIA IN CARDIOVASCULAR SURGERY

Abstract

Objective: Evaluate and assess the efficacy of IV ketorolac “as post CABG” surgery analgesic as
compared to IV morphine infusion and study the respiratory depressant and sedative effects of IV morphine “as
compared to ketorolac” and assessment of efficacy of ketorolac “as a morphine sparing post-operative analgesic”.
Study Design: Comparative or analytic. Setting: This study was carried out in Armed Forces Institute of Cardiology
(AFIC/NIHD). Subject: 150 IHD patients were selected by non-probability convenience sampling technique between
ages of 30-50 years undergoing CABG with NYHA class 1. Patients of COPD, Peptic ulcer disease, NSAID allergies,
having deranged renal, liver function or coagulation profile, Addicts and alcoholics were excluded. Interventions: ASA
1 patients were selected on pre-anaesthetic assessment. In all patients anaesthesia was induced with IV midazolam
0.2mg/kg propofol 2mg/kg and morphine 0.5mg/kg body wt and maintained with propofol infusion 50:g/kg/min. Patients
were divided into three groups of 50 patients each i.e morphine group, morphine and ketorolac group and ketorolac
group. Main Outcome Measures: Analgesia, sedation and respiratory depression was studied in three groups.
Results: Quality of pain relief was best in the morphine group. The onset of pain relief was similar in all three groups.
A high sedation score was seen frequently in morphine group. A few cases of mild sedation were noted in the morphine
+ ketorolac group .Patients were fully awake in the ketorolac group. A high incidence of respiratory depression was
also noted in the morphine group. There was no incidence of respiratory depression in morphine+ketorolac group and
ketorolac group. Conclusion: This study has demonstrated that ketorolac can provide acceptable analgesia in many
patients with severe pain. Ketorolac has no apparent advantage over morphine in terms of pain relief and ketorolac
gives ideal results when it is combined with opioid analgesics.