الفهرس 
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Abstract
Fractures of the forearm are extremely common; Pain relief is of greatest importance in forearm fractures which may need manipulation immediately for reduction followed by operative intervention.
Bier’s Block (Intravenous regional anesthesia or IVRA), regional nerve blocks and sedation have been compared to general anesthesia to evaluate the efficacy, effectiveness and safety in treating such patients.
IVRA essentially consists of injecting local anesthetic solutions into the venous system of an upper or lower extremity that has been exsanguinated by compression or gravity and that has been isolated by means of a tourniquet from the central circulation. It is a regional anesthetic technique that is easy to perform, with success rates varying between 94% and 98%. For these reasons, it remains a popular choice among anesthesiologists. It is a simple, safe, and effective technique of providing anesthesia for short surgical procedures on the hand and forearm for an anticipated duration of 60 to 90minute.
Lidocaine is the most frequently used local anesthetic for IVRA. Various adjuncts have been tried to hasten the onset, maintain adequate muscle relaxation, reduce tourniquet pain, and increase the duration of analgesia with ketorolac and paracetamol being notable mentions.
There is good evidence to recommend NSAIDs in general and ketorolac in particular, for improving postoperative analgesia. Ketorolac is the only NSAID that is approved for intravenous use and it acts by interference with the synthesis of inflammatory mediators. The addition of paracetamol during IVRA with lidocaine decreased tourniquet pain, increased anesthesia quality, and decreased postoperative analgesic consumption.
We designed this study to compare the effect of 20 mg ketorolac to 300 mg of paracetamol when added to lidocaine for IVRA on postoperative pain scores, their effect on tourniquet pain, sensory and motor block and postoperative analgesic consumption.
This interventional, controlled single blinded clinical trial was carried out in Assiut University Hospital. After approval from local ethical committee and written informed consent from all participants, Fifty-one patients were randomly assigned to three groups;
• group I (The control group):Patients received IVRA lidocaine plus saline (n = 17).
• group II (Paracetamol group):
Patients received IVRA lidocaine and paracetamol 300 mg plus IV saline (n = 17).
• group III (Ketorolac group):
Patients received IVRA lidocaine and ketorolac 20 mg plus saline (n = 17)
The results of this study showed that Patients in ketorolac group experienced less postoperative pain indicated by lower VAS scores at 1st,2nd,4th,8th hour postoperatively and delayed timing of first analgesic request in the PACU when compared to control group and paracetamol group. No significant differences were found as regard hemodynamic parameters, intra or postoperative complications.