Volume 83, Issue 9 (December 2025)
Tehran Univ Med J. 2025, 83(9): 656-665 |
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Shafa S, Zabetian H, Kalani N, Deylami M, Ravaghi A, Ziyaei M et al . Comparison of the effects of pethidine, ketorolac, and a combination of pethidine and ketorolac on the rate of hemodynamic changes in patients undergoing orthopedic surgery of the femur and tibia: a triple-blind randomized clinical trial study. Tehran Univ Med J. 2025; 83 (9) :656-665
URL: http://tumj.tums.ac.ir/article-1-13862-en.html
URL: http://tumj.tums.ac.ir/article-1-13862-en.html
Shahram Shafa1, Hassan Zabetian2, Navid Kalani3, Mansoor Deylami4, Ali Ravaghi5, Maryam Ziyaei6, Reza Sahraei *7
1- Department of Orthopedics, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
2- Department of Anesthesiology, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
3- Research Center for Social Determinants of Health, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
4- Department of Anesthesiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
5- Department of Emergency Medicine, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnord, Iran.
6- Department of Emergency Medicine, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
7- Department of Anesthesiology, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran. ,sahraeir1345@gmail.com
2- Department of Anesthesiology, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
3- Research Center for Social Determinants of Health, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
4- Department of Anesthesiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
5- Department of Emergency Medicine, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnord, Iran.
6- Department of Emergency Medicine, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
7- Department of Anesthesiology, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran. ,
Abstract: (101 Views)
Background: Hemodynamic changes during surgery can be affected by the choice of anesthesia and anesthesia method, because different anesthetic drugs can change the baseline hemodynamic status and responses to painful stimuli. Understanding these factors can help improve surgical outcomes. Therefore, the aim of this study was to compare the effects of pethidine, ketorolac, and a combination of pethidine and ketorolac on the rate of hemodynamic changes in patients undergoing orthopedic surgery of the femur and tibia.
Methods: The present study was a triple-blind, randomized clinical trial conducted over a six-month period from June to November 2019 on 59 patients undergoing lower extremity orthopedic surgery (femur and tibia) under spinal anesthesia at Peymanieh Hospital, Jahrom, Iran. Patients were divided into 4 groups: pethidine, ketorolac, placebo, and a combination of ketorolac and pethidine. Systolic and diastolic blood pressure, heart rate, and arterial blood oxygen saturation were measured before spinal, after spinal, 15 minutes after surgery, 30 minutes after surgery, 45 minutes after surgery, 60 minutes after surgery, 90 minutes after surgery, and during recovery (when leaving recovery).
Results: The ketorolac, pethidine, placebo, and ketorolac-pethidine groups were matched in terms of age, gender, and anesthesia class. No statistically significant difference between the ketorolac, pethidine, placebo, and ketorolac-pethidine groups in terms of systolic and diastolic blood pressure and heart rate. The percentage of oxygen saturation was significant before and after spinal, 15 minutes after the operation (p<0.05). No significant difference at other times.
Conclusion: The present study demonstrated that in patients undergoing orthopedic surgery of the femur and tibia under spinal anesthesia, the administration of ketorolac, pethidine, or their combination had no significant effect on systolic blood pressure, diastolic blood pressure, or heart rate compared to placebo. However, pethidine alone caused a transient and significant reduction in oxygen saturation percentage during the early phases (prior to spinal anesthesia, immediately after, and up to 15 minutes postoperatively), which is clinically noteworthy.
Methods: The present study was a triple-blind, randomized clinical trial conducted over a six-month period from June to November 2019 on 59 patients undergoing lower extremity orthopedic surgery (femur and tibia) under spinal anesthesia at Peymanieh Hospital, Jahrom, Iran. Patients were divided into 4 groups: pethidine, ketorolac, placebo, and a combination of ketorolac and pethidine. Systolic and diastolic blood pressure, heart rate, and arterial blood oxygen saturation were measured before spinal, after spinal, 15 minutes after surgery, 30 minutes after surgery, 45 minutes after surgery, 60 minutes after surgery, 90 minutes after surgery, and during recovery (when leaving recovery).
Results: The ketorolac, pethidine, placebo, and ketorolac-pethidine groups were matched in terms of age, gender, and anesthesia class. No statistically significant difference between the ketorolac, pethidine, placebo, and ketorolac-pethidine groups in terms of systolic and diastolic blood pressure and heart rate. The percentage of oxygen saturation was significant before and after spinal, 15 minutes after the operation (p<0.05). No significant difference at other times.
Conclusion: The present study demonstrated that in patients undergoing orthopedic surgery of the femur and tibia under spinal anesthesia, the administration of ketorolac, pethidine, or their combination had no significant effect on systolic blood pressure, diastolic blood pressure, or heart rate compared to placebo. However, pethidine alone caused a transient and significant reduction in oxygen saturation percentage during the early phases (prior to spinal anesthesia, immediately after, and up to 15 minutes postoperatively), which is clinically noteworthy.
Type of Study: Original Article |
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