IS PREOPERATIVE KETOROLAC A USEFUL ADJUNCT TO REGIONAL ANESTHESIA FORINGUINAL HERNIORRHAPHY

Background: Nonsteroidal antiinflammatory drugs (NSAIDs) have become a popular component of analgesia regimens, particularly in combination with narcotics. We questioned whether there might also be a place for their use in conjunction with regional anesthesia and whether there wa s a preferable route for NSAID administration. Methods: Ilioinguinal a nd field blocks were performed preoperatively on seventy patients unde rgoing outpatient inguinal hernia repair. Patients were divided into a control group who received no ketorolac and four study groups who rec eived a preoperative dose of 30 mg ketorolac by one of the following r outes: IV, IM, PO, or intrawound (IW). The ketorolac in the Mi group w as mixed in the syringe with the local anesthetic used for the field b lock. IV and IM groups also received ketorolac at the time of the preo perative regional anesthesia and the PO group received the dose at lea st one hour preoperatively. All patients received a similar general an esthetic intraoperatively. Results: Postoperative pain scores and anal gesic requirements were lowest for the IM, IV, and IW groups. Pain sco res and analgesic requirements for the PO group were less than for the control group but more than for the other three groups. Analgesic eff icacy therefore ranked: IM=IV=IW>PO>Control. Though no differences wer e found between groups in the time to discharge from the recovery room , the ease of nursing care paralleled the findings for pain scores and analgesia requirements. Conclusion: Beyond the analgesia provided by the regional anesthesia of the ilioinguinal and field blocks, the preo perative use of ketorolac further reduced postoperative pain scores an d the need for additional postoperative analgesic medication. Comparab le outcomes for the IV, IM, and IW groups indicate the lack of any ben efit to concentrating the non-steroidal anti-inflammatory drug at the wound (IW) or to achieving high blood levels rapidly (IV). In conclusi on, ketorolac is a useful supplement to ilioinguinal plus field block regional anesthesia for hernia surgery and is most effective administe red parenterally.