Preemptive Ketorolac for Shoulder Tip Pain During Cesarean Section
Preemptive Ketorolac for Shoulder Tip Pain During Cesarean Section
Our study is planned to investigate if pre-emptive Ketorolac would decrease the incidence of
 intraoperative shoulder tip pain and improve discomfort during Caesarean section.
Cesarean section (CS) is the most frequent major abdominal surgery among women worldwide .
 Shoulder pain, is a common but mostly neglected consequence of caesarean section and little
 is known about this entity. The pain is described as sharp, deep and referred, usually begins
 intraoperatively and continue for 2-3 days after surgery.

 Although infant and maternal death rates have been decreased after CS, this procedure is not
 free of risks for mother and child. Compared with normal vaginal delivery (NVD), some CS
 complications include: more haemorrhage; increased postoperative pain; atelectasia; nausea;
 vomiting; risks for wound infection or wound opening and shoulder pain.

 Although spinal anaesthesia (SA) is a common technique for CS in the past decade, and there
 are many studies about CS complications, there are few studies about shoulder pain as one of
 CS complications. Kikuchi et al. reported that women undergoing cesarean section under
 compined spinal epidural anaethesia experience shoulder-tip pain with great frequency. Our
 study was planned and performed to investigate if pre-emptive Ketorolac would decrease the
 incidence of intraoperative shoulder pain and improve discomfort during CS.

 Sharp pain observed in these patients was experienced in the shoulder area or under the
 diaphragm. The pain was described as coming from deep within the shoulder, and in some, would
 seem to radiate from the right chest. The pain spread down the upper right arm and up the
 right neck in some, resulting in muscular tension and pain. The cause of this pain is
 postulated to sub-diaphragmatic air trapping, subdiaphragmatic clot or peritoneal irritation.
 This type of shoulder pain is reported commonly after laparoscopic surgery and it is reported
 that heat, massage and drinking hot water or hot tea with fresh lemon relieves this pain.
Inclusion Criteria:

 -  nulligravida healthy women who delivered single term baby, with American Society of
 Anesthesiologists physical status 1 or 2

 Exclusion Criteria:

 previous caesarean section; pre-eclampsia; gestational diabetes; trauma; fractures or
 chronic pain in shoulder joints, forearms, upper limbs; cardiovascular or biliary system
 disorders; women undergoing emergency caesarean; previous history of abdominal surgery;
 conditions preventing spinal block, including local infection; coagulopathies; haemodynamic
 instability