Ketorolac analgesia for inguinal hernia repair is not improved by peripheral administration

Kardash, Kenneth J.; Garzón, J F G; Velly, Ana Míriam; Tessler, Michael J.

doi:10.1007/bf03015771

Cited by 9 publications

(3 citation statements)

References 13 publications

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“…These results are consistent with a previous report in rats, where local infiltration of ketorolac in combination with dexamethasone reduced postoperative pain scores only until 2 h after laparotomy, which could be attributed to the systemic absorption of drugs provided by the large vascularization of the abdominal cavity [22]. In human surgical patients undergoing hernia repair, no significant analgesic benefits were found with local infiltration of NSAIDs compared to systemic injection of meloxicam [18] or ketorolac [23]. Moreover, some aspects of our experimental protocol may have contributed to the apparent lack of a prolonged postoperative analgesic effect of ropivacaine in combination with meloxicam.…”

Section: Discussionsupporting

confidence: 92%

Comparison of perioperative analgesia using the infiltration of the surgical site with ropivacaine alone and in combination with meloxicam in cats undergoing ovariohysterectomy

et al. 2020

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Background: Infiltration of the surgical site with local anesthetics combined with nonsteroidal anti-inflammatory drugs may play an important role in improving perioperative pain control. This prospective, randomized, blinded, controlled clinical trial aimed to evaluate intraoperative isoflurane requirements, postoperative analgesia, and adverse events of infiltration of the surgical site with ropivacaine alone and combined with meloxicam in cats undergoing ovariohysterectomy. Forty-five cats premedicated with acepromazine/meperidine and anesthetized with propofol/isoflurane were randomly distributed into three treatments (n = 15 per group): physiological saline (group S), ropivacaine alone (1 mg/kg, group R) or combined with meloxicam (0.2 mg/kg, group RM) infiltrated at the surgical site (incision line, ovarian pedicles and uterus). End-tidal isoflurane concentration (FE'ISO), recorded at specific time points during surgery, was adjusted to inhibit autonomic responses to surgical stimulation. Pain was assessed using an Interactive Visual Analog Scale (IVAS), UNESP-Botucatu Multidimensional Composite Pain Scale (MCPS), and mechanical nociceptive thresholds (MNT) up to 24 h post-extubation. Rescue analgesia was provided with intramuscular morphine (0.1 mg/kg) when MCPS was ≥6.Results: Area under the curve (AUC) of FE'ISO was significantly lower (P < 0.0001) in the RM (17.8 ± 3.1) compared to S (23.1 ± 2.2) and R groups (22.8 ± 1.1). Hypertension (systolic arterial pressure > 160 mmHg) coinciding with surgical manipulation was observed only in cats treated with S and R (4/15 cats, P = 0.08). The number of cats receiving rescue analgesia (4 cats in the S group and 1 cat in the R and RM groups) did not differ among groups (P = 0.17). The AUC of IVAS, MCPS and MNT did not differ among groups (P = 0.56, 0.64, and 0.18, respectively). Significantly lower IVAS pain scores were recorded at 1 h in the RM compared to the R and S groups (P = 0.021-0.018). There were no significant adverse effects during the study period. Conclusions: Local infiltration with RM decreased intraoperative isoflurane requirements and resulted in some evidence of improved analgesia during the early postoperative period. Neither R nor RM infiltration appeared to result in long term analgesia in cats undergoing ovariohysterectomy.

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Section: Discussionsupporting

confidence: 92%

Comparison of perioperative analgesia using the infiltration of the surgical site with ropivacaine alone and in combination with meloxicam in cats undergoing ovariohysterectomy

et al. 2020

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“…Six studies evaluated the effects of conventional NSAIDs (tenoxicam, meloxicam) ( Table 3 )17, 19, 69–72. Overall, there was no difference in pain scores at rest or on movement, need for supplementary analgesics, and time to first analgesic request.…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery

Joshi

Rawal

Kehlet

2012

Journal of British Surgery

124

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Field block with, or without wound infiltration, either as a sole anaesthetic/analgesic technique or as an adjunct to general anaesthesia, is recommended to reduce postoperative pain. Continuous local anaesthetic infusion of a surgical wound provides a longer duration of analgesia. Conventional non-steroidal anti-inflammatory drugs or cyclo-oxygenase 2-selective inhibitors in combination with paracetamol, administered in time to provide sufficient analgesia in the early recovery phase, are optimal. In addition, weak opioids are recommended for moderate pain, and strong opioids for severe pain, on request.

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“…In pain management after elective caesarean delivery, Lavand'homme et al in 2007 showed that continuous intra‐wound infusion with diclofenac offered better pain control, without adverse effect as compared with the same dose administered systemically by intermittent intravenous injection [31]. None of the patient in the study had significant post‐operative bleeding [31, 33, 34] or wound infection [4, 31, 33] and delay wound healing [4, 31]. Despite these findings, NSAID wound infiltration has not been included in many peri‐operative analgesic guidelines although generic NSAIDs are cheap and readily available especially in the middle and low‐resourced surgical settings.…”

Section: Introductionmentioning

confidence: 99%

A Double‐Blind, Randomized Controlled Trial of Pre‐incision Wound Infiltration Using Diclofenac Versus Bupivacaine for Post‐operative Pain Relief in Open Thyroid and Parathyroid Surgery

et al. 2020

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Background Pre‐incision wound infiltration using NSAID is an alternative method to manage post‐operative pain in surgery. It is postulated that NSAID delivered peripherally exerts efficient analgesic and anti‐inflammatory effect with minimal systemic complication. This study explored the efficacy of using diclofenac for wound infiltration in open thyroidectomy and parathyroidectomy as compared to conventional agent, bupivacaine. Methodology The study was designed as a double‐blind, randomized controlled trial involving 94 patients who underwent open thyroidectomy or parathyroidectomy in Hospital Pulau Pinang, Malaysia, from November 2015 to November 2016. The study compared the efficacy of pre‐incision wound infiltration of diclofenac (n = 47) versus bupivacaine (n = 47) in post‐operative pain relief. Wound infiltration is given prior to skin incision. Mean pain score at designated time interval within the 24‐h post‐operative period, time to first analgesia, total analgesic usage and total analgesic cost were assessed. Results Ninety‐four patients were recruited with no dropouts. Mean age was 49.3 (SD = 14.2) with majority being female (74.5%). Ethnic distribution recorded 42.6% Chinese, 38.3% Malay, followed by 19.1% Indian. Mean duration of surgery was 123.8 min (SD = 56.5), and mean length of hospital stay was 4.7 days (SD = 1.8). The characteristics of patient in both groups were generally comparable except that there were more cases of total thyroidectomy in the diclofenac group (n = 31) as compared to the bupivacaine group (n = 16). Mean pain score peaked at immediate post‐operative period (post‐operative 0.5 h) with a score of 3.5 out of 10 and the level decreased steadily over the next 20 h starting from 4 h post‐operatively. Pre‐incision wound infiltration using diclofenac had better pain control as compared to bupivacaine at all time interval assessed. In the resting state, the mean post‐operative pain score difference was statistically significant at 2 h [2.1 (SD = 1.5) vs. 2.8 (SD = 1.8), p = 0.04]. During neck movement, the dynamic pain score difference was statistically significant at post‐operative 1 h [2.7 (SD = 1.9) vs. 3.7 (SD = 2.1), p = 0.02]; 2 h [2.7 (SD = 1.6) vs. 3.7 (SD = 2.0), p = 0.01]; 4 h [2.2 (SD = 1.5) vs. 2.9 (SD = 1.7), p = 0.04], 6 h [1.9 (SD = 1.4) vs. 2.5 (SD = 1.6), p = 0.04] and 12 h [1.5 (SD = 1.5) vs. 2.2 (SD = 1.4), p = 0.03]. Mean dose of tramadol used as rescue analgesia in 24 h duration was lower in the diclofenac group as compared to bupivacaine group [13.8 mg (SD = 24.9) vs. 36.2 mg (SD = 45.1), p = 0.01]. The total cost of analgesia used was significantly cheaper in diclofenac group as compared to bupivacaine group [RM 3.47 (SD = 1.51) vs. RM 13.43 (SD = 1.68), p < 0.01] or [USD 0.83 (SD = 0.36) vs. USD 3.21 (SD = 0.40), p < 0.01]. Conclusion Pre‐incision wound infiltration using diclofenac provides better post‐operative pain relief compared to bupivacaine for patient who had underwent open thyroidectomy or parathyroidectomy. Diclofenac is cheap and easily a...

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Ketorolac analgesia for inguinal hernia repair is not improved by peripheral administration

Abstract: Adding ketorolac to lidocaine infiltration for hernia repair does not improve or prolong postoperative analgesia compared to systemic administration.

Cited by 9 publications

References 13 publications

Comparison of perioperative analgesia using the infiltration of the surgical site with ropivacaine alone and in combination with meloxicam in cats undergoing ovariohysterectomy

Comparison of perioperative analgesia using the infiltration of the surgical site with ropivacaine alone and in combination with meloxicam in cats undergoing ovariohysterectomy

Evidence-based management of postoperative pain in adults undergoing open inguinal hernia surgery

A Double‐Blind, Randomized Controlled Trial of Pre‐incision Wound Infiltration Using Diclofenac Versus Bupivacaine for Post‐operative Pain Relief in Open Thyroid and Parathyroid Surgery

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