• Steve Clerc, Henri Vuilleumier, Philippe Frascarolo, Donat R Spahn, and Jean-Patrice Gardaz.
• Department of Anesthesiology, University Hospital, Lausanne, Switzerland.
• Clin J Pain. 2005 Jan 1; 21 (1): 101-5.

ObjectiveThe aim of the study was to assess whether coadministration of S(+) ketamine or ketorolac would enhance or prolong local analgesic effect of bupivacaine after inguinal hernia repair.DesignProspective double-blind randomized study evaluating pain intensity after surgery under general anesthesia.SettingOutpatient facilities of the University Hospital of Lausanne.PatientThirty-six ASA I-II outpatients scheduled for elective day-case inguinal herniorraphy.InterventionAnalgesia strategy consisted of a wound infiltration and an inguinal field block either with 30 mL bupivacaine (0.5%) or with the same volume of a mixture of 27 mL bupivacaine (0.5%) + 3 mL S(+) ketamine (75 mg) or a 28 mL bupivacaine (0.5%) + 2 mL ketorolac (60 mg). Postoperative analgesic regimen was standardized.Outcome MeasuresPain intensity was assessed with a Visual Analog Scale, a verbal rating score, and by pressure algometry 2, 4, 6, 24, and 48 hours after surgery.ResultsThe 3 groups of patients experienced the highest Visual Analog Scale pain score at 24 hours, which was different from those at 6 and 48 hours (P < 0.05). Apart from a significantly lower pain sensation (verbal rating score) in the ketorolac group at 24 and 48 hours and only at 48 hours with ketamine, there were no other differences in pain scores, pain pressure thresholds, or rescue analgesic consumption between groups throughout the 48-hour study period.ConclusionThe addition of S(+)-ketamine or ketorolac only minimally improves the analgesic effect of bupivacaine. This may be related to the tension-free hernia repair technique associated with low postoperative pain.

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