Pre-emptive analgesia may prevent or reduce hyper-analgesia, inhibit inflammation and reduce pain by blocking the synthesis of prostaglandins in response to tissue damage caused by surgery. NSAIDS are used frequently for treatment of post-surgical pain along with opioids. However, they may not be as effective as opioids. Ketorolac (one of the NSAIDS) used post-operatively can be used for pre-emptive analgesia to reduce opioid requirements in patients undergoing total abdominal hysterectomy (TAH).

This was a double blind controlled trial with random allocation. After approval from hospital ethics committee, seventy ASA I and II patients between the ages of 40- 60 years undergoing total abdominal hysterectomy (TAH) were included in the study after informed consent. They were divided into two equal groups (35 patients in each group). Each patient was shown the VAS (Visual Analogue Scale) preoperatively and explained how to rate her severity of pain on the scale. Thirty five patients, preemptive group (P group) received 30 mg of Ketorolac and 35 patients, control group (C group) received placebo (saline) intravenously (I.V) 30 minutes before induction of anesthesia. Intra-operatively, an increase in blood pressure and heart rate were taken as an indicator of pain during surgery and Injection Nalbuphine 0.05-mg/kg was administered as rescue analgesia. Postoperatively, for the initial 24 hours, pain was assessed on a VAS (VAS-score) of 1-3 considered as mild pain, 4-7 as moderate pain & 8-10 as severe pain). If score was more than 3 a top up dose of Inj. Nalbuphine 0.05 mg/kg was administered intravenously. Total Nalbuphine consumption during the intraoperative as well as initial 24 hours postoperative period was recorded for each patient.

Thirty five patients in study group (P group) and 35 patients in the control group (C group) completed the study. Overall, there was no statistically significant difference in pain scores as well as opioid requirements in both these groups. (P > 0.05).

The results suggested that there was no decrease in opioid requirements in patients who received Inj. Ketorolac pre-emptively, therefore Ketorolac has little or no place as a preemptive analgesic.