Multimodal analgesia using paracetamol combined with ketorolac after laparoscopic major surgery

Background: Effective postoperative pain relief is the cornerstone of enhanced postoperative recovery. Pain after laparoscopic surgery can be caused by many factors such as the trocar incision associated, the incision in the abdominal wall and manipulations in the peritoneal cavity. Therefore, it is necessary to apply multimodal analgesia. The research question is whether the pain after laparoscopic surgery is low level. Objective: To evaluate the effectiveness of multimodal analgesia using paracetamol combined with intravenous ketorolac and morphine rescue compared with intravenous paracetamol alone and morphine rescue after laparoscopic major surgery. Materials and methods: In a randomized controlled clinical trial, 70 patients aged 18 years and older, classified ASA I - III, undergoing laparoscopic surgery were randomly divided into two groups. The Para-Keto group received intravenous ketorolac and paracetamol, the Para group received intravenously paracetamol and both groups received patient-controlled intravenous morphine. VAS pain scores at rest, on movement, morphine consumption in 48 hours, flatus time, time to sit up, patient satisfaction and side effects. Results: The Para-Keto group had lower pain scores at rest and on movementand shorter flatus, sitting up time than the Para group (p < 0.05). “Very satisfied” in the Para-Keto group was statistically significantly higher than the Para group (71.4% vs 28.6%). The level of satisfaction in the Para group accounted for 60.0%, the average satisfaction rate accounted for 11.4%. The average total amount of morphine used in 48 hours in the Para-Keto group was significantly lower than that in the Para group (p < 0.05). The rates of itching, vomiting and nausea in the two groups were low and did not differ statistically between the two groups. No patient experienced respiratory depression. Conclusions: Multimodal analgesia by using paracetamol combined with intravenous ketorolac and rescue with intravenous morphine after laparoscopic major surgery was better than paracetamol combined with morphine rescue after laparoscopic surgery. Laparoscopic surgery still have severe pain and needed additional pain killer Key words: Laparoscopic surgery, multimodal analgesia.