USE OF PREINCISIONAL KETOROLAC IN HERNIA PATIENTS - INTRAVENOUS VERSUS SURGICAL SITE

Background and Objectives. This study was designed to determine whethe r administration of ketorolac directly in the surgical site results in enhanced analgesia. Methods. A randomized double-blind study was unde rtaken at a university-affiliate tertiary care hospital. Thirty outpat ients undergoing unilateral inguinal hernia repair by one of two surge ons under local anesthesia with sedation were evaluated. Patients were invited to participate in this investigation at the time of the preop erative surgical visit. Patients who had a contraindication to the use of ketorolac or who refused repair under local anesthesia with sedati on were excluded. Patients received ketorolac 60 mg either via the par enteral route or directly in the surgical site (mixed with the local a nesthetic). The outcome measures included visual analog pain scores, m easured at two different times in the hospital, pain scores at rest an d with movement 24 hours after surgery, time to first analgesic, and t otal analgesic requirement. Results. The study revealed lower 24 hour movement-associated pain scores (P < .02), increased time to first ana lgesic (P < .03), and decreased oral analgesic consumption (P < .0002) in the surgical site group. Conclusions. Ketorolac provides enhanced patient comfort when it is administered in the surgical site in patien ts undergoing inguinal hernia repair. It is recommended that clinician s add ketorolac to the local anesthetic solution in such patients.