Drawing a different conclusion.

Sir,

I read with interest the article published in your journal.[1] In this study, authors compared the analgesic effect in two groups of patients: (a) who received ketorolac 30 mg I.M, with (b) those who received ketorolac 15 mg + vitamin B complex (CBV). They found the pain score was not significantly different in two groups. From this they infer that CBV provides additive analgesic effect to ketorolac.

A different conclusion can be drawn from the study that ketorolac achieves its ceiling analgesic effect with the 15 mg dose and doubling the dose would not increase its analgesic effect.In my opinion, the study they designed is not appropriate to test their hypothesis. Various option are available, for instance, they could have third group in their study who receive only ketorolac 15 mg.

Another point I want to make is that NSAIDs are cyclo-oxygenase inhibitors and thus inhibit platelets function. The coagulation studies mentioned in the study (prothrombin time, partial time of thromboplastin and international normalized ratio) are not the tests to assess platelets function. Furthermore, NSAIDs are also prostaglandin synthesis inhibitors. Theoretically, they can impair the uterine contraction, which is required after the delivery of the newborn. Though this study looked at the vaginal bleeding but authors did not mention whether there any difference in two groups.