A Comparative Study on the Analgesic Efficacy of Ketorolac Versus Tramadol in Managing Postoperative Pain Following Median Sternotomy in Cardiac Surgery Patients

Abstract

Background: Postoperative pain following median sternotomy remains a significant challenge despite advances in analgesic strategies. Effective pain control is crucial to prevent hemodynamic instability and enhance recovery after cardiac surgery.

Objective: To analyze the analgesic effects of Ketorolac and Tramadol injections on postoperative pain reduction at 12 and 24 hours following median sternotomy.

Methods: This was a prospective, double-blinded, randomized controlled trial conducted at a single tertiary care center in Puducherry, India, over a six-month period. Sixty patients undergoing cardiac surgery via sternotomy were randomized to receive either intravenous Ketorolac or Tramadol, and postoperative pain was assessed using VAS and Wong–Baker FACES scales at 12 and 24 hours.

Results: A total of 92 patients were assessed for eligibility, out of which 60 were enrolled and randomized equally into two groups: Group A (Ketorolac) and Group B (Tramadol). Baseline characteristics such as age, gender, comorbidities, diagnosis, and type of cardiac surgery were comparable between the groups. The mean age was 56.2 ± 13.4 years in the Ketorolac group and 51.7 ± 11.2 years in the Tramadol group. There was no significant difference in the duration of mechanical ventilation (11.5 hours in both groups), but patients in the Ketorolac group had significantly shorter ICU stays (3.1 ± 0.3 vs. 3.4 ± 0.5 days, p = 0.002) and hospital stays (6.5 ± 0.5 vs. 7.3 ± 0.9 days, p < 0.001). At 24 hours, the Ketorolac group showed significantly lower pulse rate and diastolic blood pressure. Pain scores were significantly lower in the Ketorolac group at both 12 and 24 hours based on VAS and Wong–Baker FACES scales (p < 0.05), indicating better analgesic efficacy.

Conclusion: Ketorolac demonstrated superior analgesic efficacy compared to Tramadol in managing postoperative pain following cardiac surgery via sternotomy. It was associated with lower pain scores, greater hemodynamic stability, and shorter ICU and hospital stays.