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Locally Administered Ketorolac and Bupivacaine for Control of Postoperative Pain in Breast Augmentation Patients: Part II. 10-Day Follow-Up

Mahabir, Raman C. M.Sc., M.D.; Peterson, Brian D. M.D.; Williamson, J Scott M.D.; Valnicek, Stan M. M.D.; Williamson, David G. M.D.; East, William E. M.D.

Plastic and Reconstructive Surgery: February 2008 - Volume 121 - Issue 2 - p 638-643
doi: 10.1097/01.prs.0000298112.52389.e1

Background: Previously, it was shown that locally applied intraoperative ketorolac and bupivacaine significantly reduced pain in the recovery room. The objective of this study was to test the effectiveness of the same solution over the first 10 days.

Methods: This study was a prospective, randomized, double-blind clinical trial with ethical approval. Fifty submuscular breast augmentation patients were enrolled, and informed consent was obtained. Standard anesthetic and surgical protocols were followed. Either normal saline or ketorolac and bupivacaine (30 mg and 150 mg, respectively) were placed into the pocket. The power of this study to detect a 20 percent difference was 0.90, and values of p < 0.05 were considered significant. The primary outcome was pain measured with the visual analogue pain scale recorded in a take-home diary. The secondary outcome was codeine usage.

Results: Forty-five patients completed the study. Of the patients who did not, three were in the normal saline group (n = 22) and two were in the ketorolac-bupivacaine group (n = 23). The ketorolac-bupivacaine combination significantly reduced pain over the first 5 days. By the tenth day postoperatively, the effect had dissipated. These patients also used less codeine. There were no significant complications.

Conclusion: Locally applied, intraoperative ketorolac and bupivacaine significantly reduced pain for 5 days after surgery in women who had undergone primary breast augmentation.

Kelowna, British Columbia, Canada

From the Division of Plastic and Reconstructive Surgery, and the Department of Anesthesia, Okanagan Health Surgical Unit, University of British Columbia, and the Kelowna General Hospital.

Received for publication July 31, 2006; accepted September 30, 2006.

Presented at the 37th Annual Meeting of the American Society of Aesthetic Plastic Surgeons, in Vancouver, British Columbia, Canada, April 16, 2004, and awarded the Gaspar Anastasi Award.

Brian D. Peterson, M.D., Okanagan Health Surgical Center, Unit 401, 3320 Richter Street, Kelowna, British Columbia V1W 4V5, Canada,

Disclosure: None of the authors has any financial interest, consultancies, stock ownership or other equity interests, patent licensing arrangements, or any payments for conducting or publicizing the study described in this article.

©2008American Society of Plastic Surgeons