Use of preincisional ketorolac in hernia patients - Intravenous versus surgical site

Background and Objectives. This study was designed to determine whether administration of ketorolac directly in the surgical site results in enhanced analgesia. Methods. A randomized double-blind study was undertaken at a university-affiliate tertiary care hospital. Thirty outpatients undergoing unilateral inguinal hernia repair by one of two surgeons under local anesthesia with sedation were evaluated. Patients were invited to participate in this investigation at the time of the preoperative surgical visit. Patients who had a contraindication to the use of ketorolac or who refused repair under local anesthesia with sedation were excluded. Patients received ketorolac 60 mg either via the parenteral route or directly in the surgical site (mixed with the local anesthetic). The outcome measures included visual analog pain scores, measured at two different times in the hospital, pain scores at rest and with movement 24 hours after surgery, time to first analgesic, and total analgesic requirement. Results. The study revealed lower 24 hour movement-associated pain scores (P < .02), increased time to first analgesic (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 patients undergoing inguinal hernia repair. It is recommended that clinicians add ketorolac to the local anesthetic solution in such patients.