Does the addition of ketorolac and dexamethasone to lidocaine intravenous regional anesthesia improve postoperative analgesia and tourniquet tolerance for ambulatory hand surgery?

BACKGROUND: The inability to provide effective postoperative analgesia is one of the major disadvantages of intravenous regional anesthesia (IVRA). We designed a prospective, randomized, double blind study to evaluate the analgesic effectiveness of adding both ketorolac and dexamethasone to lidocaine for IVRA.

METHODS: The study involved 45 patients undergoing ambulatory hand surgery. They were randomly allocated into three groups: Group L, Group LK and Group LDK. Group L received 3 mg x kg-1 lidocaine; Group LK received 3 mg x kg-1 lidocaine + 30 mg ketorolac; and Group LDK received 3 mg x kg-1 lidocaine for IVRA + 8 mg dexamethasone + 30 mg ketorolac for IVRA using a 40 mL solution. Sensory and motor block onset and recovery times were recorded. Tourniquet pain and pain at the operative site were assessed by a visual analog scale. In the first 24 h after surgery, opioid requirements and total analgesic consumption, including side effects, were noted.

RESULTS: Sensory and motor block onset and recovery times were similar in all groups. Patients in Groups LK and LDK required less alfentanyl for control of intraoperative and early postoperative pain. Further, patients in Groups LK and LDK reported significantly lower pain scores compared to those in Group L (P<0.001). Patients in Groups LK and LDK required fewer postoperative ketorolac tablets (2.2+/-1.6 and 1.3+/-0.6 tablets, respectively) in the first 24 h after surgery and had significantly longer periods during which they required no analgesics (524 min and 566 min, respectively) compared to those in Group L (3.8+/-1.3 tablets; 122 min, P<0.001).

CONCLUSION: IVRA with lidocaine and with the inclusion of ketorolac and dexamethasone provides effective perioperative analgesia for patients undergoing ambulatory hand surgery, when compared to the use of lidocaine alone or lidocaine with ketorolac IVRA.