الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Pain therapy after Cesarean delivery is important for comfort and to allow early ambulation to facilitate care of the newborn. In addition, optimization of postoperative pain treatment could allow early return to a regular diet and normal bladder and bowel function, thus facilitating early discharge from hospital.
Effective perioperative pain relief with low incidence of side-effects can only be achieved by a combination of analgesics with different mechanisms of action, preferably administered before surgical incision like opioids, NSAIDS, paracetamol, but opioids are usually omitted at the induction of general anesthesia for cesarean delivery because of concerns about placental transfer resulting in neonatal respiratory depression.
Endotracheal intubation is one of the most invasive stimuli in anesthesia, particularly during induction and after tracheal intubation. It is usually well tolerated by normotensive patients, but even short-lasting stimulation has been associated with increased morbidity and mortality in patients with recent myocardial infarction, hypertension, preeclampsia, and cerebrovascular pathology such as tumors, aneurysms or increased intracranial pressure.
So the concept of preemptive analgesia became more popular in cesarean section with evidence of better pain relief and decreasing stress of intubation.
Ketorolac is a non-steroidal anti-inflammatory drug (NSAIDs) that belongs to the class of heterocyclic acetic acid derivatives. It is a potent analgesic which when given intraoperative it provides postoperative analgesia similar to that associated with opioids but is associated with significantly less emesis, respiratory depression, pruritis and sedation compared with opioids. It is administered as tromethamine salt orally, intravenously, intramuscularly and as a topical ophthalmic solution.
The FDA has recently approved an intranasal formulation of ketorolac tromethamine for short-term management of moderate to moderately severe pain requiring analgesia at the opioid level.
Paracetamol is indicated for the short-term treatment of moderate pain, especially following surgery and for the short-term treatment of fever. Administration by intravenous route is clinically justified by an urgent need to treat pain or hyperthermia and/or when other routes of administration are not possible.