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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 following ambulatory hand surgery., Methods: The patient population in this double-blind study consisted of 60 patients scheduled for elective ambulatory hand surgery, who were divided into three groups of 20 each. All patients received IVRA with 40 mL 0.5% lidocaine and 5 mL 1% lidocaine infiltrated into the surgical site. Group 1, the control group, received 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 assessed by a 10-cm visual analog scale. VAS) 1 hour and 2 hours after tourniquet deflation. In the postanesthesia care unit analgesia was provided with fentanyl until the VAS score reached 3 or lower. Patients were instructed to take one Tylenol No. 3 (acetaminophen with codeine) tablet every 4 hours as needed at home. They were contacted the next day, and the time to first additional narcotics and the total number of tablets taken were recoded., Results: No differences in demographic variables or in operative, tourniquet, or discharge times were noted among the groups. The VAS scores were significantly lower in the two groups who received ketorolac than in the control group (P < .05); the mean time from tourniquet release to first medication was 109 +/- 73 minutes 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)., Conclusion: Ketorolac provides similar postoperative analgesia after ambulatory hand surgery when administered with lidocaine either by IVRA or by wound infiltration.

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.

Background: Intrathecal opioids routinely are administered to surgical patients to provide prolonged postoperative analgesia. This study evaluated the dose-response effects of intrathecal fentanyl in an elderly patient population undergoing lower extremity revascularization procedures., Methods: Surgical anesthesia was induced using a continuous spinal technique. No patient received perioperative antiemetics or opioids. Postoperatively, after complete regression of spinal anesthesia, patients received via the spinal catheter either 0, 5, 10, 20, 40, or 50 micrograms fentanyl. Blood pressure, heart rate, respiratory rate, oxyhemoglobin saturation, and visual analog pain scores were recorded approximately every minute for 15 min after study drug administration. After this initial observation period, blood pressure, heart rate, respiratory rate, oxyhemoglobin saturation were recorded every 15 min for the next 2 h, then every 30 min thereafter. A verbal analog pain score, with 0 equivalent to no pain and 10 the worst pain imaginable, was obtained with each set of vital signs. The study was concluded when the verbal analog pain score was > or = 3, the patient was medicated, and the time was recorded. Any side effects, such as respiratory depression, nausea, vomiting, and pruritus, were recorded., Results: Minimal analgesia was derived from the 0-, 5-, and 10-micrograms doses. Beginning at 20 micrograms, patients experienced the onset of satisfactory analgesia (visual analog pain scores < 3) within 4 min. All patients in the 40- and 50-micrograms groups had excellent analgesia (visual analog pain scores < 1) within 10 min. No patient experienced respiratory depression (respiratory rate < 9 breaths/min), hypoxemia (oxyhemoglobin saturation < 90%), or any hemodynamic alterations (20% change greater or less than baseline heart rate or blood pressure). In the 50-micrograms group, five of ten patients complained of pruritus., Conclusions: Results indicate that 40 micrograms intrathecal fentanyl provides satisfactory analgesia for approximately 5 h in an elderly patient population, with a low incidence of side effects.