The efficacy of ketorolac as an adjunct to the Bier block for controlling postoperative pain following nontraumatic hand and wrist surgery.

Research indicates that using a combination of ketorolac and lidocaine in the administration of a Bier block results in significant postoperative analgesia and decreased inflammation; however, the optimal dose of ketorolac to coadminister with the local anesthetic has not been established. This study was performed to determine if a 20-mg dose of ketorolac is effective in providing prolonged postoperative analgesia without adverse effects. A total of 55 patients (29 lidocaine-ketorolac, 26 lidocaine-placebo) were enrolled in this randomized, double-blind, placebo controlled study. Pain was measured using a 0 to 10 visual analogue scale and analysis of postoperative analgesic requirements. Incidence of bruising and postoperative analgesic satisfaction scores were determined 48 hours following discharge. No difference in demographic variables, adverse effect profiles, or satisfaction scores was noted between groups. Visual analogue scale scores were increased in the placebo group in the hospital but not following discharge to home. There was also a prolonged time to postoperative analgesic requests in the ketorolac group compared with the placebo group following discharge to home, achieving statistical significance for the time to second analgesic request (P = .012). Based on the results of this study we recommend that 20 mg ketorolac be considered in intravenous regional anesthesia.