الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
This study was carried out on sixty patients scheduled for mastectomy with lymph nodes axillary dissection. Exclusion criteria included patients with known contraindications to regional anesthesia namely: patients refusal, coagulopathy, active peptic ulcer, cirrhosis of the liver with ascities, hypertention, allergy to local anesthetic, infection at the thoracic paravertebral injection site, congenital anomalies and severe obesity (body mass index >35 kg/m2 ). The day before surgery, careful preoperative evaluation was done. Patients were randomly assigned using closed envelopes into 2 groups (each of 30):- Group BK received general anesthesia, paravertebral block and 30 mg ketorolac in 500 ml IV saline infusion intraoperative. Group BS received general anesthesia, paravertebral block and 500 ml IV saline infusion intraoperative. Haemodynamic variables were measured before and after block placement every 10 minutes till the end of the operation. The duration of surgery was recorded also. After emerging from anesthesia ,the patients were transferred to the postanesthetic care unit (PACU) for monitoring of vital signs .They were asked about the severity of pain. VRS was used for monitoring of pain at rest and with abduction of the operated arm at the following time interval 1, 2, 4, 6, 12 and 24 hr postoperative. The postoperative complications such as nausea and vomiting were recorded. In this study, the postoperative pain scores at rest and during abduction of the ipsilateral arm of the surgery 90? were significantly lower in group BK compared to group BS at 1st , 2nd , 4th and 6th hours. The requirements of intra-operative and postoperative analgesics were significantly less in group BK compered to group BS. Nausea was recorded in two patients while vomiting was recorded in one patient in group BK also nausea was recorded in three patients while vomiting was recorded in two patient in group BS. From our study we conclude that the administration of intravenous ketorolac intra-operatively after paraveterbral block produces adequate analgesia during the early postoperative period rather than using paravertebral block alone. Also we conclude that the use of intravenous ketorolac with paraveterbral block reduces the need for additional analgesics.