Ketorolac versus paracetamol adjunct to lidocaine for intravenous regional anesthesia in patients undergoing hand and forearm surgeries

Abstract

Background We aimed to compare the influence of adding ketorolac as an adjunct to lidocaine for intravenous regional anesthesia (IVRA) on postoperative analgesia and both motor and sensory blockade. Patients and methods A total of 51 patients undergoing operations under IVRA were randomly assigned to receive lidocaine 3 mg/kg (group 1), lidocaine 3 mg/kg plus ketorolac 30 mg (group 2), and lidocaine 3 mg/kg plus paracetamol 300 mg (group 3). Results There was rapid sensory and motor blockade onset and slower recovery in ketorolac group when compared with the other groups and also in paracetamol when compared with lidocaine (P≤0.05). The mean time to first request of intramuscular diclofenac was longer in the ketorolac group (5.6±0.8 h) compared with the lidocaine group (2.5±0.4 h) and paracetamol group (4.4±0.3 h, P=0.000). The total consumption of intramuscular diclofenac was 75 mg (75–150 mg) in the ketorolac group versus 75 mg (75–150 mg) in the paracetamol group and 150 mg (75–150 mg) in lidocaine group (P=0.001). The mean visual analog scale (VAS) scores were lesser in the ketorolac group when compared with the other groups at all time points (P≤0.05), except before tourniquet and immediately after tourniquet, with the highest VAS (P>0.05). Patient satisfaction was better in the ketorolac group. Conclusion Overall, 20 mg of ketorolac is more effective than 300 mg of paracetamol when added to lidocaine for IVRA, with faster onset and slower recovery of both sensory and motor blockade, lower postoperative VAS scores, delayed timing of the first analgesic request, and decreased total analgesic requirements.