Intravenous Regional Anesthesia Using Lidocaine and Ketorolac

Abstract

Nonsteroidal antiinflammatory drugs (NSAIDs) interfere with the synthesis of inflammatory mediators and can supplement postoperative pain relief. We postulated that using the parenterally available NSAID ketorolac (K) as a component of intravenous regional anesthesia (IVRA) would suppress intraoperative tourniquet pain and enhance postoperative analgesia. Sixty patients were assigned randomly and blindly to receive either intravenous (i.v.) saline and IVRA with 0.5% lidocaine, IV K and IVRA 0.5% lidocaine, or i.v. saline and IVRA 0.5% lidocaine with K. The patients who received IVRA K reported significantly less intraoperative tourniquet pain, with lower verbal analog pain scores at 15 and 30 min after tourniquet inflation. Similarly, IVRA-K patients experienced less postoperative pain with lower visual analog scale (VAS) pain scores at 30 and 60 min, and required no fentanyl for control of early postoperative pain in the postanesthesia care unit (PACU). They also required fewer analgesic tablets in the first 24 h (1.9 +/- 1.4 Tylenol No. 3 tablets compared to the other two groups, 4.6 +/- 1.3 and 3.0 +/- 1.1; P < 0.05). We conclude that K improves IVRA with 0.5% lidocaine both in terms of controlling intraoperative tourniquet pain and by diminishing postoperative pain.

A systematic review of adjuncts for intravenous regional anesthesia for surgical procedures

“…19 Three studies had a systemic control group. 17,18,20 All of these studies were supportive in terms of postoperative outcome.…”

“…8 Ten studies investigated opioids [6][7][8][9][10][11][12][13][14][15] and one tramadol 1 6 (Table I). Six studies investigated non-steroidal antiinflammatory drugs (NSAIDs) 8,[17][18][19][20][21] and five clonidine 8,[22][23][24][25] (Table II). Five studies investigated muscle relaxants, 6,7,[26][27][28] three alkalization, [29][30][31] one potassium 3 2 and two temperature 33,34 (Table III).…”

“…Six studies involving 370 patients have investigated various NSAIDs as the sole adjunct 8,[17][18][19][20][21] to IVRA (Table II). The agents investigated were ketorolac, 17,19,21 tenoxicam 8,18 and aspirin.…”

“…The agents investigated were ketorolac, 17,19,21 tenoxicam 8,18 and aspirin. 2 0 One study compared IVRA ketorolac to local infiltration of ketorolac into the wound margin.…”

“…17,19,21 Only the study by Reuben et al 1 7 looked at the potential intraoperative benefit of NSAIDs added to LA. They compared tourniquet pain scores and found significantly fewer patients had a pain score of >3/10 during the first 30 min when ketorolac 60 mg was added.…”