Abstract
Background: It is the basic duty of all healthcare professionals to relieve pain, and the most important indication
for treating pain after surgery is humanitarian.
Objectives: Comparing the effects of intravenous morphine, tramadol and ketorolac on post operative pain in
patients undergoing modified radical mastectomy
Study design: A randomized, double blind trial.
Methods: Sixty patients randomly were assigned to receive either IV morphine 5mg (Group I, n = 20), tramadol
100 mg (Group II, n = 20), or ketorolac 60 mg (Group III, n = 20) at the end of surgery. Assessment parameters
included hemodynamics, respiratory rate, oxygen saturation, sedation score, VAS score, time of first analgesic
request, total amount of analgesics consumption, and side effects in the first 24 hours.
Results: The mean time to the first request for rescue analgesia was significantly prolonged in group II (11.00±
2.49 hrs ranged from 8- 15 hrs) and group III (8± 1.89 hrs ranged from 6.0 -10.0 hrs) in comparison to group I
(3.75± 0.89 hrs ranged from 3 – 5 hrs) (P <0.001). Total post-operative amount of analgesics consumption over 24
hrs in the three studied groups was (7.00 ± 2.51 mg ranged from 5- 10 mg of morphine) in group I;(160.00± 68.06
mg ranged from 100-300 mg of tramadol) in group II;(80.00± 19.47 mg ranged from 60– 120 mg of ketorolac) in
group III. The mean (VAS) score in studied groups, showed no significant difference between the three studied
groups at all time periods(P >0.05), but there was a significant decrease in the (VAS) in each group separately over
the course of 24 hrs in comparison to base line values (P <0.007). No significant differences were observed in the
mean systolic and diastolic blood pressure values, respiratory rate and oxygen saturation between groups.
Conclusion: intravenous morphine, tramadol and ketorolac had similar analgesic efficacy on the post-operative
pain in patients undergoing modified radical mastectomy.
Key words: Breast Cancer Surgery; Postoperative Pain; morphine, tramadol, ketorolac