[Post-cesarean section analgesia with low spinal morphine doses and systemic nonsteroidal anti-inflammatory drug: diclofenac versus ketoprofen.]. / Analgesia pós-operatória em cesarianas com a associação de morfina por via subaracnóidea e antiinflamatório não esteróide: diclofenaco versus cetoprofeno.

BACKGROUND AND OBJECTIVES: The association of low spinal morphine doses and muscular diclofenac is effective to control postoperative pain after Cesarean section under spinal anesthesia. Ketoprofen, also an NSAID, may be advantageous over diclofenac because it may be intravenously administered. This study aimed at comparing the analgesic efficacy of diclofenac and ketoprofen in association to low spinal morphine doses in the immediate postoperative period of patients submitted to Cesarean section under spinal anesthesia. METHODS: Participated in this prospective study 44 healthy parturients, physical status ASA I or II, submitted to Cesarean section under spinal anesthesia with 15 mg hyperbaric bupivacaine and 28 microg morphine. Patients were randomly allocated into two groups, 90 minutes after anesthetic induction: Group D (n = 22): 75 mg muscular diclofenac; and Group K (n = 22): 100 mg intravenous ketoprofen diluted in 100 ml of 5% glucose in 20 minutes. Pain was evaluated immediately before NSAID administration and then every hour for six hours, using the Visual Analog Scale of Pain (VAS - 0 cm meaning no pain and 10 cm the worst possible pain). Rescue analgesia was provided by intravenous PCA pump (1mg bolus morphine with 7 minutes lockout interval, without basal infusion and maximum 20 mg morphine dose in 4 hours). The following parameters were evaluated: pain intensity, need for rescue analgesia, cumulative morphine consumption in the first 6 hours following NSAID administration, and the incidence of pruritus, nausea, vomiting and respiratory depression. RESULTS: Both groups were similar in pain intensity, cumulative morphine doses and incidence of pruritus, nausea and vomiting in the first six hours following NSAID administration. CONCLUSIONS: When associated to low spinal morphine doses, ketoprofen was similar to diclofenac in providing postoperative analgesia in the first six hours following Cesarean section under spinal anesthesia.