Intradermal ketorolac for reduction of epidural back pain

Between 30 and 45% of all parturients receiving epidural laboring analgesia complain of postpartum back pain. Although long-term or chronic back pain has been reported, our study focuses on acute or short-term back pain that resolves within 72 h. The purpose of this randomized double-blind, placebo-controlled investigation was to determine if a ketorolac/lidocaine intradermal anesthesia combination could decrease post-epidural back pain. A total of 81 non-complicated parturients requesting epidural analgesia were approached for inclusion and randomized to receive either 3 mL of 1% lidocaine (control group) or 3 mL of 1% lidocaine with 6 mg ketorolac (experimental group) for dermal anesthesia. A 0-10 verbal numeric scale was used to assess pain at rest and with activity at 24 and 72 h. Demographics, mode of delivery, and duration of labor were noted. A chi2 test was used to analyse frequency data and a Student's t-test and generalized estimation equation were used to analyze ordinal and interval data. Demographics, mode of delivery and length of labor were similar between groups. Significantly lower verbal numeric scores were noted in the experimental group at the 24-h active measurements after vaginal delivery and at 24 and 72 h for both active and resting measurements after cesarean delivery. Based on these findings it can be recommended that intradermal ketorolac given at the time of epidural catheter placement may result in a reduction in post-epidural back pain in the parturient, especially in the event of cesarean delivery.