Overview
we aim to compare the analgesic efficacy of two intravenous ketorolac dosing regimens as part of a multimodal analgesic protocol that includes local wound infiltration for postoperative pain management after elective cesarean delivery.
Description
Spinal anesthesia will be achieved by injecting 10 mg hyperbaric bupivacaine 0.5% plus 25 mcg fentanyl Prophylactic vasopressor will be administered in all patients, Following delivery, all patients will receive a single dose of dexamethasone (8 mg) along with the first dose of intravenous ketorolac. Subsequent ketorolac doses will be administered every 8 hours.
After closing the fascia, the subcutaneous layer will be infiltrated with 30 mL of 0.25% bupivacaine.
Postoperatively, if the Numeric rating scale is \> 3, intravenous nalbuphine 0.1 mg/kg titrated to response, with maximum single dose of 20 mg and maximum daily dose of 160 mg.
Eligibility
Inclusion Criteria:
- full-term, singleton, pregnant women,
- aged 18-35 years,
- scheduled for elective cesarean delivery under spinal anesthesia
Exclusion Criteria:
- American Society of Anesthesiologists (ASA) physical class III or more
- multiple gestation. Patients with a history of allergy to any of the study drugs,
- renal impairment,
- gastrointestinal bleeding or ulceration
- inflammatory bowel disease,
- chronic pain or regular opioid use.
- Inability to comprehend the numeric pain scale (NRS) or the ObsQoR-11 score
- requirement for conversion to general anesthesia after spinal anesthesia