دراسة مقارنة بين الكيتورولاك وريديا و الحصار المغبني في نهاية العمل الجراحي للتسكين بعد الجراحة

الملخص EN

Background& Objective: chronic pain after inguinal hernia repair is an adverse outcome that affects about 12 % to 54 % of patients.

Ilioinguinal and iliohypogastric ( IG – IH ) nerve block has been widely used in patients undergoing inguinal hernia repair.

Ketorolac is indicated for the short term (less than 5 days)management of pain and appears to be particularly useful in the immediate postoperative period.

A standard dose of Ketorolac provides analgesia equivalent to 6 – 12 mg of morphine administered by the same route.

The interval to onset is also similar to morphine, but Ketorolac has a longer duration of action (6 – 8 h).

what is the best method for pain management after inguinal procedures? Is there any difference between (IG – IH) nerve block, and Ketorolac IV postoperatively (pain scores, early movement, nausea, vomiting ...)? Materials & Methods: 61 patients ( aged 16-45 year , ASA I , II ) undergoing inguinal surgery were included randomly and prospectively in this study at AL –Assad & AL-Mowasah University hospitals during one year.

The patients were randomized to receive either Ketorolac (30 mg IV loading dose and 15 mg IV every 6h for 24 h) or(IG – IH) nerve block with bupivacaine (5 ml, 0.5 %) at the end of surgery.

Results: the VAS score at recovery was( 0.23 ± 0.93 )in Ketorolac group, and(1.09± 0.59 ) in ( IG – IH ) nerve block group , but at the sixth hour VAS score was (1.50 ± .16) in Ketorolac group and ( 1.67 ± 1.59 ) in ( IG – IH ) nerve block group.

None of the patients had nausea or vomiting in (IG – IH) nerve block group but one patient had vomiting at the sixth hour in Ketorolac group.

The mean time for ability to walk was (2.37 ± 0.85) hour in (IG – IH) nerve block group, and (4.60 ± 1.45) h in Ketorolac group.

The mean time for ability to get the first meal was (4.61 ± 1.35) h in nerve block group and (5.0 ± 1.25) h in Ketorolac group.

Conclusion: both methods Ketorolac IV & (IG – IH) nerve block are good for pain management postoperatively in inguinal procedures but the (IG – IH) nerve block is better than Ketorolac because the patients can walk earlier.