Comparison of Pain Relief between Preoperative Administration of Intravenous Ketorolac and Oral Pregabalin in Patients Undergoing Surgery for Mandibular Fracture: A Randomized Clinical Trial

Abstract

Introduction: Preemptive analgesia is one of the techniques to manage postoperative pain which increases patient satisfaction and decreases the duration of hospitalization. The present study aimed to evaluate and compare the pain relief achieved by preoperative intravenous ketorolac and oral pregabalin in patients undergoing surgery for mandibular fractures. Materials and methods: In the present clinical trial, sixty patients with unilateral fractures of the symphysis, body and angle of the mandible, who were candidate for the open reduction, were assigned to two groups randomly. In group A, 30-mg intravenous ketorolac injections, and in group B, 150-mg pregabalin capsules were administrated one hour preoperatively. The severity of pain was determined using Visual Analog Scale up to 24 hours postoperatively. Finally, the total doses of an opioid analgesic medication (pethidine) prescribed for each patient in mg during the first 24 hours, and the time for the request of the first analgesic dose in minutes for each patient were recorded, and their means were compared between the two groups. The data were analyzed with descriptive statistics (frequencies, percentages, means, and standard deviations), independent-samples t-test, chi-squared test, and repeated-measures of ANOVA using SPSS 19. The normal distribution of data was evaluated with the Kolmogorov-Smirnov test. Statistical significance was defined at P<0.05. Results: The severity of pain was the maximum immediately after surgery, which decreased gradually during the 24-hour postoperative period (P<0.0001). The mean severity of pain immediately after regaining consciousness and the mean pain score during the 24-hour postoperative period were lower in the pregabalin group compared to the ketorolac group (P<0.0001). The dose of the opioid used in the ketorolac group was slightly higher, but the diffirence was not statical significant(P=0.152). Also, the time for requesting an opiod dose was shorter than in the pregabalin group, but the diffirence was not statical significant (P=0.338). Conclusion: The administration of 150-mg oral pregabalin, one hour preoperatively was more effective than the intravenous administration of 30-mg ketorolac in relieving postoperative pain.