COMPARISON OF WOUND INFILTRATION WITH KETOROLAC VERSUS INTRAVENOUS REGIONAL ANESTHESIA WITH KETOROLAC FOR POSTOPERATIVE ANALGESIA FOLLOWINGAMBULATORY HAND SURGERY

Background and Objectives. The purpose of this study was to assess the analgesic effectiveness of ketorolac administered with lidocaine via intravenous regional asesthesia (IVRA) or via wound infiltration follo wing ambulatory hand surgery. Methods. The patient population in this double-blind study consisted of 60 patients scheduled for elective amb ulatory hand surgery, who were divided into three groups of 20 each. A ll patients received IVRA with 40 mL 0.5% lidocaine and 5 mL 1% lidoca ine infiltrated into the surgical site. Group 1, the control group, re ceived no additional medications; group 2 had 60 mg ketorolac added to the lidocaine used for IVRA; and group 3 had 60 mg ketorolac added to the lidocaine used for wound infiltration. Postoperative pain was ass essed by a 10-cm visual analog scale, VAS) 1 hour and 2 hours after to urniquet deflation. In the postanesthesia care unit analgesia was prov ided with fentanyl until the VAS score reached 3 or lower. Patients we re instructed to take one Tylenol No. 3 (acetaminophen with codeine) t ablet every 4 hours as needed at home. They were contacted the next da y, and the time to first additional narcotics and the total number of tablets taken were recoded. Results. No differences in demographic var iables or in operative, tourniquet, or discharge times were noted amon g the groups. The VAS scores were significantly lower in the two group s who received ketorolac than in the control group (P < .05); the mean lime from tourniquet release to first medication was 109 +/- 73 minut es for group 1,467 +/- 431 for group 2, and 393 +/- 312 for group 3 (P < .05); and the number of tablets taken was 4.1 +/- 1.3 for group 1, 1.8 +/- 1.2 for group 2, and 2.0 +/- 1.3 for group 3 (P < .05). Conclu sion. Ketorolac provides similar postoperative analgesia after ambulat ory hand surgery when administered with lidocaine either by IVRA or by wound infiltration.