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Comparison of oral ketorolac and oral magnesium for postoperative pain management in anorectal surgery: A randomized double-blind clinical trial.

  • 2026-01
  • The Journal of international medical research 54(1)
    • Seyed Jalal Eshagh Hoseini
    • Farzaneh Sadat Ghazi
    • Mohsen Eshraghi
    • Mostafa Vahedian
    • Mohammad Reza Pashaei
    • Mojdeh Bahadorzadeh
    • Sajjad Ahmadpour

Study Design

Type
Randomized Controlled Trial (RCT)
Sample size
n = 104
Population
104 patients undergoing anorectal surgery
Methods
double-blind, randomized controlled trial; oral magnesium (250 mg daily) vs oral ketorolac (10 mg daily); medicine given 2 h after operation then every 12 h for 10 days; pain measured at 24-hour intervals using VAS
Blinding
Double-blind
Duration
10 days
  • Large Human Trial
ObjectivePostoperative pain is one of the most common complications after anorectal surgery and can delay recovery, lengthen hospital stay, and reduce patient comfort. Non-steroidal anti-inflammatory drugs are widely used due to their strong analgesic and opioid-sparing effects but are associated with gastrointestinal, renal, and bleeding risks. Magnesium may provide analgesic benefits with fewer adverse effects. However, evidence regarding its efficacy in the oral form and direct comparison with non-steroidal anti-inflammatory drugs remains limited. In this study, we aimed to compare the analgesic effectiveness of oral magnesium with that of oral ketorolac to identify the more suitable analgesic drug in these patients.MethodsIn this double-blind, randomized controlled trial, 104 patients undergoing anorectal surgery were randomly divided into 2 groups. Group 1 received oral magnesium (250 mg daily), and Group 2 received oral ketorolac (10 mg daily). The medicine was given to the patients 2 h after the operation and then every 12 h for 10 days. Pain levels were measured at 24-hour intervals after the surgery using the visual analog scale.ResultsBoth treatments significantly reduced postoperative pain over time (p < 0.001). The ketorolac group showed lower mean pain scores on days 1, 3, and 5 (p < 0.001), whereas no significant differences were observed on postoperative days 7 and 10 (p = 0.089 and 0.092, respectively). Narcotic consumption was higher in the magnesium group than in the ketorolac group (p < 0.001).ConclusionsOral magnesium demonstrated a clinically meaningful analgesic effect comparable to that of oral ketorolac from postoperative day 5 onward, suggesting that it is a safe non-opioid alternative for postoperative pain management in anorectal surgery. Further multicenter trials with larger samples are warranted to confirm these findings.

Research Insights

  • Magnesium→Increased Narcotic Consumption

    Narcotic consumption was higher in the magnesium group than in the ketorolac group (p < 0.001).

    Effect
    Harmful
    Effect size
    Moderate
    Dose
    250 mg daily
  • Magnesium→Reduced Pain

    Both treatments significantly reduced postoperative pain over time (p < 0.001).

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    250 mg daily
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