The influence of timing and route of administration of intravenous ketorolac on analgesia after hand surgery

A double-blind clinical trial was conducted on 47 patients scheduled for hand surgery under general anaesthesia to determine whether ketorolac given as part of an intravenous regional anaesthesia technique could provide better postoperative analgesia than ketorolac given intravenously either before or after surgery. Patients were randomly allocated to one of three groups to receive ketorolac 20 mg: intravenously in the non-operative arm before surgery (systemic presurgery group); intravenously to the operative arm after tourniquet inflation (regional presurgery group); intravenously in the non-operative arm after surgery (systemic postsurgery group). Postoperative pain scores were similar in the systemic presurgery and regional presurgery groups. The mean visual analogue summary pain score during the 24 h after surgery was 12.2 mm higher in the systemic postsurgery group than in the systemic presurgery group (95% CI: 0.8-23.7 mm, p = 0.037). There were no clinically important differences in mean postoperative visual analogue pain scores between the three study groups. There were no statistical differences in the mean postoperative morphine requirements between the three study groups. There is no benefit, in terms of improved postoperative analgesia, in giving ketorolac as an intravenous regional anaesthetic compared with systemic administration before surgery. The administration of ketorolac after surgery, rather then before, is not supported.