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Locally applied Ketorolac and Bupivicaine with epinephrine for the control of postoperative pain in breast augmentation patients Mahabir, Raman Chaos

Abstract

One of the difficulties that continues to challenge reconstructive and aesthetic surgeons is postoperative pain control. Developments in anaesthesia have increased the understanding of pain and it is now accepted that there is a role for pre-empting it. Research with systemic non-steroidal anti-inflammatory drugs and local anaesthetics has been encouraging. The use of locally applied non-steroidal anti-inflammatory drugs in combination with local anaesthetics has not been studied. The objective of this study was to test the effectiveness of locally administered, intraoperative Ketorolac and Bupivicaine with epinephrine at reducing pain in the first two-hours of the postoperative period. Ethical approval was obtained from the Ethics Review Board of the Okanagan / Similkameen Health Region through the Kelowna General Hospital and the Medical Director of the Okanagan Plastic Surgery Center. The study was designed as a prospective, randomized, triple-blind, clinical trial. One hundred consecutive breast augmentation patients were enrolled and informed consent was obtained from each patient. A standard anaesthetic protocol and surgical procedure were followed. The intervention was divided into four groups of twenty-five patients that received either normal saline, Ketorolac only, Bupivicaine only or Ketorolac and Bupivicaine. The primary outcome was pain as measured by the Visual Analog Pain Scale. The secondary outcome was time spent in the recovery room. Other variables were considered for their effect on postoperative pain. All patients completed the study. The power of this study was 0.90 and confidence intervals of 95% were used to determine significance. The findings of this study allow rejection of the null hypothesis and support the alternate hypothesis that in women undergoing primary augmentation mammaplasty, intraoperative irrigation of Ketorolac combined with Bupivicaine with epinephrine into the surgical wound reduced pain in the postoperative period. It did not appear that anaesthesiologist, anaesthesia time, surgeon, OR time, difficulty of dissection or implant size had a significant impact on postoperative pain. Time in the recovery room was not different between the current standard of care and the Ketorolac and Bupivicaine patients. However, there was a trend that Ketorolac and Bupivicaine patients did spend less time in the recovery room than the Bupivicaine only patients.

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