Comparative study between the analgesic effect of ketorolac when administrated intravenous preoperatively versus when added to local anesthesia in squint surgery

Abstract

Background: This study aimed to investigate the safety and the analgesic and anesthetic efficacy of preoperative intravenous ketorolac as well as combined ketorolac with local anesthesia (LA) for peribulbar block. Methods: This trial enrolled adults scheduled for strabismus surgery under peribulbar block who were allocated into three groups (n = 30). The control group (C) received LA mixture containing lidocaine (2%, 10 ml) and hyaluronidase (5 IU/ml). The ketorolac group (K) received ketorolac (30 mg, intravenously) 30 minutes before LA injection. The ketorolac local group (KL) received an LA mixture to which ketorolac (4 mg/ml) was added. Results: The onset of anesthesia was significantly shorter in the KL group than in the K group (39.3 ± 6.9 versus 58.5 ± 13.4 sec, p < 0.001), and each was also significantly shorter compared to the control group (67.8 ± 16.1). The onset of akinesia was significantly shorter in the KL group than in the K group (95.2 ± 14.0 versus 106.5 ± 14.9, p < 0.001). The block duration was significantly longer in the KL group than in the K group and the control group. The pain was less in the KL group than in the K group with significant differences between the medians of VAS score. The time to the 1st analgesic dose was significantly longer in the KL group compared to the K group (5.4 ± .7 versus 4.9 ± .5, p < 0.001). Conclusions: The combination of ketorolac with LA mixture in the peribulbar block was effective; providing better anesthesia, increasing the duration of the block, reducing intraoperative and postoperative pain, and delaying the need for postoperative supplementary analgesia. Both intravenous preoperative ketorolac administration and its addition to the LA mixture were safe with minimal side effects.