Analgesic Efficacy of Morphine Versus Concurrent Use of Ketorolac and Acetaminophen In Mandibular Bone Surgery
Ali Hossein Mesgarzadeh1, Vahid Dehghan Manshadi1,*, Javad Yazdani1, Kourosh Taheri Talesh1, Samira Farnia2
Background: Pain, a major issue in medical treatment, is one of the major concerns for both the clinician and the patient. Postoperative acute pain management during the initial hours is very important and can prevent side effects. Analgesics (acetaminophen, opioids) and nonsteroidal anti-inflammatory drugs are used as medications for pain control. Objective: This study was performed to compare the analgesic efficacy of morphine versus the concurrent use of ketorolac and intravenous acetaminophen after mandibular bone surgery. Materials and Methods: In this prospective, single-centered, randomized, double-blind clinical trial study, a total of 60 patients referred to Imam Reza Hospital in 2015 for mandibular bone surgery were randomized post-surgery into two groups: In group 1, acetaminophen (1 g in 100 cc normal saline solution) and ketorolac (30 mg in 100 cc normal saline solution) were infused every 6 hours. In group 2, morphine sulfate (0.1 mg/kg in 100 cc normal saline solution) was infused every 4 hours. The pain level was recorded on the visual analogue scale (VAS) at 1, 2, 4, 6, 12, and 24 hours after surgery. Results: Significant differences were found between the two groups in most hours. The mean pain level according to the VAS in group 1 and group 2 were 6.87±2.43 vs.7.20±2.06 (p = 0.560) for the 1st hour post operation, 5.80±2.76 vs. 4.03±2.25 (p = 0.008) for the 2nd hour post operation, 5.03±3.01 vs. 3.10±2.11 (p = 0.005) for the 4th hour post operation, 3.37±3.03 vs. 1.77±1.92 (p = 0.017) for the 6th hour post operation, 2.10±2.44 vs. 0.73±1.28 (p = 0.008) for the 12th hour post operation and 1.30±1.91 vs. 0.60±1.28 (p = 0.101) for the 24th hour post operation. No significant difference was observed in the 1st and 24th hour post-operation. Nausea was seen in the groups as one of the side effects with no significant difference. Conclusion: Morphine showed better efficiency in pain control than the concurrent use of ketorolac and intravenous acetaminophen.
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