# Effect of a Single Preventive Intravenous Dose of Ketorolac and Paracetamol on Reducing Postoperative Pain in Septorhinoplasty Patients: Double-Blind Randomized Clinical Trial

## TL;DR

This study found that a single dose of IV paracetamol or ketorolac before surgery reduced postoperative pain in septorhinoplasty patients compared to a placebo.

## Contribution

The study demonstrates that IV paracetamol is a viable alternative to ketorolac for postoperative pain management in septorhinoplasty.

## Key findings

- Both ketorolac and paracetamol significantly reduced pain scores compared to placebo one hour post-surgery.
- The need for rescue analgesic pethidine hydrochloride was significantly lower in the treatment groups.
- Paracetamol and ketorolac showed similar efficacy in pain reduction after septorhinoplasty.

## Abstract

Effective pain management is crucial in septorhinoplasty and remains a significant challenge. This study investigated the effect of ketorolac and paracetamol on pain control in septorhinoplasty patients and assessed their efficacy in reducing the need for rescue analgesics.

This double-blind randomized clinical trial was conducted at Madar-Koodak Hospital (Shiraz, Iran), in 2022. Ninety-nine patients were randomly assigned to three groups to
receive ketorolac 30 mg (n=33), paracetamol 1000 mg (n=33), and normal saline (n=33), respectively. All the medications were administered intravenously (IV) 30 min before surgery.
The randomization procedure followed the block randomization method. If the pain did not subside, patients were also given a single dose of pethidine hydrochloride (25 mg).
Pain intensity was measured using visual analog scale (VAS) 1 hour and 6 hours after surgery. The data were analyzed using SPSS software, using paired t tests, ANOVA, and Chi square tests.

One-hour post-surgery, VAS scores in the ketorolac and paracetamol groups were significantly lower than in the placebo group (P<0.001). The mean difference with 95% CI for ketorolac-placebo and paracetamol-placebo was -0.57 (-0.94, -0.21), and -0.79 (-1.12, -0.45), respectively. The ketorolac and paracetamol groups required significantly less pethidine hydrochloride 1 hour post-surgery than the placebo group (P<0.001). The VAS scores and requiring pethidine were not significantly different between the ketorolac and paracetamol groups.

After septorhinoplasty, the administration of 1000 mg of IV paracetamol demonstrated comparable efficacy in pain reduction to 30 mg of ketorolac. It suggested that paracetamol could serve as a viable alternative to ketorolac in preventing postoperative pain after septorhinoplasty, particularly in patients for whom non-steroidal anti-inflammatory (NSAID) drugs could not be a suitable choice.

Trial Registration Number: IRCT20180922041084N6.