Comparison of effectiveness of combination of lidocaine-ketorolac vs lidocaine alone in biers block of upper limb surgery: Focus on intraoperative and post-op pain relief.

Abstract

Objective: To compare the effectiveness of a combination of Lidocaine and Ketorolac versus Lidocaine alone in Bier’s Block for upper limb surgery, in terms of intraoperative and 12 hours postoperative pain score. Study Design: Randomized Controlled Trial (RCT). Setting: Department of Anesthesia, Aziz Fatima Hospital Faisalabad. Period: Six months (January to June’25). Methods: Following approval from the Institutional Ethical Review Committee and the College of Physicians and Surgeons Pakistan, this randomized controlled trial enrolled 100 patients fulfilling the inclusion criteria. Participants were equally divided into two groups. Group A received intravenous lidocaine 4 mg/kg after confirmation of proper tourniquet inflation and absence of distal pulse. Group B received intravenous lidocaine 4 mg/kg combined with ketorolac 30 mg under the same conditions. Postoperative assessment was initiated immediately after tourniquet release. Results: Most participants were aged 20–45 years (64%), with male predominance (76%) and majority classified as ASA-I. The lidocaine-ketorolac group demonstrated significantly lower intraoperative VAS scores at 5, 10, and 15 minutes compared with lidocaine alone (p<0.001). Postoperative pain scores at 1, 6, 12, and 24 hours were also significantly reduced in the combination group (p<0.001). Time to first analgesic request was significantly prolonged with ketorolac (163.26±32.63 vs. 87.54±24.36 minutes; p<0.001). Rescue analgesia requirement and adverse effects were numerically lower in the combination group. Conclusion: The addition of ketorolac with lidocaine increases the analgesic efficacy for both intraoperative and postoperatively in addition to extending analgesic duration for improving the effectiveness of IVRA.