Local Ketorolac Infiltration for Postoperative Pain in Open Trigger Finger Surgery: A Randomized Controlled Trial

Local Ketorolac Infiltration for Postoperative Pain in Open Trigger Finger Surgery: A Randomized Controlled Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Local Ketorolac Infiltration for Postoperative Pain in Open Trigger Finger Surgery: A Randomized Controlled Trial Thanat Auwattanamongkol, Panai Laohaprasitiporn, Yuwarat Monteerarat, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4550595/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Sep, 2024 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted 16 You are reading this latest preprint version Abstract Background Multimodal analgesia is crucial for effective postoperative pain management in minor hand surgeries, enhancing patient satisfaction. The use of local wound infiltration with Ketorolac as an adjuvant pain management strategy is proposed for open trigger finger release surgery. This study aims to compare pain scores and functional outcomes between local wound infiltration with Ketorolac and oral non-steroidal anti-inflammatory drugs. Methods This study is a double-blind, parallel design, randomized controlled trials. Sixty-nine patients underwent trigger finger surgery between December 2021 and October 2022 were randomized into one of three groups: oral Ibuprofen alone group, local Ketorolac alone group and local Ketorolac with oral Ibuprofen group. The assessment included postoperative numeric rating scale (NRS) pain score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, mobility of proximal interphalangeal (PIP) joint. and complications. Results NRS pain scores during movement of the operated fingers were significantly lower at 6 hours in local Ketorolac alone group and local Ketorolac with oral Ibuprofen group compared to oral Ibuprofen alone group. However, there were no significant differences between the groups in postoperative DASH scores, grip strength, mobility of PIP joints, and complications. Conclusions Local infiltration of Ketorolac is safe for use as an adjuvant postoperative pain management and provides superior pain control during finger movement within the first 6 hours following trigger finger surgery compared to oral NSAIDs. Clinical trial registration: Thaiclinicaltrials.org identifier: TCTR20210825002. Registered 25/08/2021. https://www.thaiclinicaltrials.org/show/TCTR20210825002 Trial registration This clinical trial was registered in the Thai Clinical Trials Registry (TCTR) on 25/08/2021: register number TCTR20210825002. https://www.thaiclinicaltrials.org/show/TCTR20210825002 trigger finger trigger digit local NSAIDs infiltration open trigger finger surgery postoperative pain Figures Figure 1 Introduction Trigger finger is a prevalent condition affecting the upper extremities in adult patients. Its occurrence is quite common, with an annual incidence rate of 28 cases per 100,000 individuals in the adult population.[ 1 – 3 ] Typically, patients suffering from trigger finger experience pain or a clicking sensation near the metacarpal head level of the hand. These symptoms can lead to difficulties in holding objects or grasping items effectively.[ 1 – 3 ] One of the treatment options available for patients with trigger finger is surgical intervention, which includes open release and percutaneous release of the A1 pulley. The success rate for open release of the A1 pulley ranges from 90–100%.[ 2 , 4 , 5 ] However, it is important to note that a small percentage (approximately 5–12%) of patients who undergo open surgical treatment may experience postoperative complications or prolonged symptoms.[ 2 , 5 , 6 ] These symptoms may include snapping, locking, or pain even after the surgery has been performed. Approximately 19% of patients may continue to experience these symptoms for more than 8 weeks after the surgical procedure.[ 6 ] The persistence of prolonged postoperative symptoms can lead to patient dissatisfaction and may also hinder the ability to perform daily activities, impacting the patient's overall quality of life. Therefore, careful consideration and monitoring of patients after surgical treatment for trigger finger are crucial to address any potential complications and ensure optimal outcomes. Multimodal analgesic drugs play a pivotal role in managing postoperative pain, even in minor hand surgeries.[ 6 ] Among the commonly prescribed medications for postoperative pain control in open trigger finger release, paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used. In contrast, opioids are rarely employed for pain management in minor surgical procedures. To provide local pain control after surgery, some surgeons have adopted the approach of administering analgesic drugs through local infiltration at the surgical site. This localized method of pain management can help alleviate discomfort and enhance patient recovery following the procedure. Ketorolac is an intravenous NSAID commonly prescribed for short-term postoperative pain control. Its unique properties make it nonirritating to human tissue, and its pKa of 3.5 enables it to concentrate in injured and inflamed tissues.[ 7 ] Due to these characteristics, ketorolac can be effectively used as a local infiltration at the surgical wound site, thereby enhancing postoperative pain control. Studies have shown that local infiltration of 30–60 mg of ketorolac has proven effective for providing local analgesia with minimal systemic absorption.[ 8 ] Moreover, research has indicated that ketorolac can effectively reduce early postoperative pain in various surgical procedures, including hindfoot arthrodesis, primary breast augmentation, and total knee arthroplasty.[ 9 – 12 ] Notably, using ketorolac as a local infiltration drug has demonstrated safety, with no evidence of serious complications reported in studies.[ 10 , 11 , 13 , 14 ] This makes ketorolac a viable option for enhancing postoperative pain control without undue risk of adverse effects. The current evidence regarding local ketorolac infiltration for postoperative pain control in hand surgery is limited. Therefore, the objective of this randomized controlled study is to assess the effectiveness of local ketorolac infiltration as compared to conventional oral NSAIDs in managing postoperative pain in patients who have undergone open trigger finger surgery. Methods Study design The study protocol underwent a thorough review and received approval from the Institutional Review Board of research involving human subjects. This study was performed in accordance with the Declaration of Helsinki and reported according to Consolidated Standards of Reporting Trials (CONSORT). Additionally, this research protocol was registered in the Clinical Trials Registry database to ensure transparency and adherence to ethical standards. Before enrolling in the study, all eligible participants were provided with comprehensive information about the study, its objectives, potential risks, and benefits. Informed consent was obtained from each participant, indicating their voluntary decision to participate in the research after fully understanding its implications. This study was a parallel design, randomized controlled trial and conducted at a tertiary care hospital from December 2021 to October 2022. The study focused on patients who underwent open trigger finger release on a single digit, with the procedure performed under local anesthesia. We included patients aged between 18 and 75 years old and presenting with a Quinell grade 2–4 single trigger digit. Patients who met any of the exclusion criteria were not included in the study. The exclusion criteria encompassed patients who had undergone prior trigger finger release in the same digit, had recurrent trigger finger, had congenital trigger finger, had experienced a fracture or tendon injury on the target digit, had inflammatory joint diseases (e.g., rheumatoid arthritis or gouty arthritis), had concomitant ipsilateral carpal tunnel syndrome and/or de Quervain's disease, had a known history of hypersensitivity to NSAIDs, had concomitant diseases that contraindicated the use of NSAIDs (e.g., chronic kidney disease stage 3, gastric ulcer, gastroesophageal reflux disease, history of gastrointestinal bleeding, coronary artery disease, cerebrovascular disease, etc.), or were pregnant or breastfeeding women. The participants in this study were randomly assigned to one of three treatment groups using a computerized randomization process in blocks of six. The results of the randomization were placed in opaque envelopes and remained sealed until the patient was positioned on the operating table. The trial drugs were also packaged within these sealed envelopes. Patients in the Ibuprofen alone group received a local injection of 1 ml of normal saline solution (NSS) before the surgical wound closure, and they were prescribed 400 mg of Ibuprofen in the form of 2 capsules, to be taken three times per day for 5 days. Patients in the Ketorolac alone group were locally injected with 1 ml of Ketorolac (30mg/ml) before surgical wound closure, and for postoperative pain management, they received oral placebo in the form of 2 capsules, to be taken three times per day for 5 days. Patients in the Ketorolac with Ibuprofen group were treated with a 1 ml injection of Ketorolac (30mg/ml) before the surgical wound closure, and they were prescribed 400 mg of Ibuprofen in the form of 2 capsules, to be taken three times per day for 5 days. In this clinical trial, a 1 ml injection of Ketorolac was used as one of the treatment drugs. This Ketorolac injection was odorless and colorless, and its appearance was indistinguishable from normal saline. To ensure blinding in the study, the Ibuprofen tablets for postoperative pain control were encapsulated in white capsules, making them visually indistinguishable from other drugs. Participants in the Ketorolac alone group received a placebo drug, which was a white capsule containing medical starch. Both the Ibuprofen capsule and the placebo capsule were made to look identical, further supporting the blinding process. This clinical trial was conducted as a double-blinded study. The patients participating in the study were not informed about which drugs they received during the trial. Additionally, the surgeon who performed the trigger finger release procedures remained unaware of the specific drug assigned to each patient, either for injection before the operation or for postoperative medications. To eliminate potential biases, a trained research coordinator was responsible for carrying out all assessments and data collection. The primary outcome of this study was the pain score, which was assessed using the numeric rating scale (NRS) at 48 hours after the trigger finger surgery. The secondary outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, range of motion (ROM) of the proximal interphalangeal (PIP) joint of the affected finger and complications that arose as a result of the treatment interventions were recorded. Study protocol and surgical technique Before the operation, participants underwent a comprehensive assessment that included interviews and preoperative examinations to collect various types of data which included preoperative NRS pain score, ROM of PIP joint of the affected finger, grip strength, and DASH score. In the operating room, the patients were positioned on the operating table with the operating arm extended. The surgical site was prepared and draped with a surgical towel to maintain a sterile environment. The patient's view of the surgical field was obstructed by the surgical draping to maintain blinding during the procedure. A tourniquet was applied to the proximal forearm to control blood flow during the surgery. The surgeon then administered 4 ml of 1% lidocaine without adrenaline for local anesthesia at the surgical site. Once the anesthesia was effective, a 1-cm longitudinal skin incision was made, followed by a longitudinal complete release of the A1 pulley. Before closing the skin, the assistant nurse opened the sealed envelope containing the specific drug assigned to the participant's treatment group as per randomization. This process was concealed from the surgeon to maintain blinding. The assistant nurse prepared the injection drug, using a 27-Gauge needle and 3 ml syringe. Then, 1 ml of Ketorolac or 1 ml of NSS was injected into subcutaneous tissue of the surgical site. The tourniquet was then removed. After checking for any bleeding and suturing the skin with Nylon 4 − 0, the surgical wound was covered with sterile dressing. In all treatment groups, patients were prescribed with a standard medication regimen to manage their postoperative care. This included 500 mg of paracetamol, which could be taken as needed every 6 hours to alleviate pain and discomfort. All participants were given 20 mg of omeprazole once a day for 5 days. Along with the standard medications mentioned above, patients in Ibuprofen group and Ketorolac with Ibuprofen group were administered 400 mg of Ibuprofen in the form of 2 capsules, to be taken three times per day for 5 days. For Ketorolac alone group, placebo capsules were prescribed and to be taken three times per day for 5 days. During the postoperative period, pain scores were assessed at specific time points. At 6 hours, 24 hours, and 48 hours after the surgery, participants were contacted by phone and asked to provide pain scores at the surgical site using the numeric rating scale (NRS), rating from 0 (no pain) to 10 (the worst pain imaginable). Participants' compliance with the prescribed medications was also recorded. This involved tracking the total number of Ibuprofen or placebo capsules and paracetamol tablets that the participants had taken up to each specific time point. Furthermore, any complications experienced by the participants were carefully monitored and documented. These complications included local bruising, hematoma, wound dehiscence, finger numbness, and surgical site infection. After the trigger finger surgery, participants were scheduled to visit for postoperative checkups. These visits occurred at 1 week, 6 weeks, and 3 months after the operation. During the first week visit, the surgical wound was assessed, and the stitches were completely removed. Participants' pain score, ROM of PIP joint using digital goniometer, grip strength using Jamar handgrip dynamometer, DASH score, and any complications experienced were collected and recorded at each visit. Additionally, participants were contacted by phone 2 weeks after the operation to inquire about their pain score. Sample size calculation The effect size of this study was determined from mean and standard deviation from each group. Sample size calculation was done using repeated measures ANOVA test to detect difference between treatment groups. Fifty-seven participants were required to detect the effect size of 0.376 with 90% statistical power and a significance level of 0.05. A twenty percent drop-out rate was expected in this study; therefore, a total of 69 participants were required for this study and randomly selected into 3 groups. Statistical analysis Continuous variables were presented as mean and standard deviation when the data followed a normal distribution, or median and interquartile range when the data exhibited a nonnormal distribution. The Kruskal-Wallis analysis of variance (ANOVA) test was used to compare differences in continuous variables among groups if the data did not conform to a normal distribution. Categorical variables were presented as percentage and compared between groups using Chi-square test or Fisher’s exact test. Post hoc analysis of postoperative NRS was analyzed using Tukey’s Honest test to identify significant differences between groups. The p-values of < 0.05 were considered statistically significant. This study was conducted utilizing an intention-to-treat analysis approach. Results A total of 90 patients with trigger finger were screened for eligibility between December 2021 and December 2022. Among them, 21 patients were excluded from the study based on the predefined exclusion criteria. One patient was planned for single digit trigger finger surgery but later changed the operation to multiple trigger finger surgery. Two patients were allergic to NSAIDs. Two patients had other disorders on the same hand. We excluded 14 patients who had contraindication to use NSAIDs. As a result, a total of 69 eligible patients were enrolled and randomly assigned into three groups. All groups equally consisted of 23 patients. The CONSORT flow diagram of this study was shown in Figure 1. The baseline characteristics of participants in each treatment group are summarized in Table 1. Overall, the characteristics were similar between the three groups. Most of the participants were male, constituting the majority in each group. The dominant hand of the participants was predominantly right-handed across all groups. The severity of trigger finger, classified by the Quinell grading system, showed no significant differences between the groups. However, most patients in all groups had Quinell grade 3 trigger finger. Preoperative pain scores at rest and during finger movement were comparable between the groups, with no significant differences observed. The preoperative status of the affected digit, as assessed by ROM of the PIP joint and grip strength, was also similar across the three groups. The postoperative pain evaluation results are presented in Table 2. The NRS pain scores during movement at 6 hours after the surgery were significantly different between the groups (p-value = 0.001). At 6 hours after surgery, the median NRS pain scores during movement in the Ketorolac alone group and ketorolac with Ibuprofen group were lower compared to the Ibuprofen alone group. When comparing the NRS pain scores during movement at 6 hours after surgery between the Ketorolac with Ibuprofen group and the Ketorolac alone group through post hoc analysis, it was found that the Ibuprofen alone group had significantly higher pain score compared to the Ketorolac with Ibuprofen group and Ketorolac alone group (Table 3). At 6 hours after surgery, the median pain score at rest of Ibuprofen alone group was higher compared to the other two groups. However, there was no statistically significant difference in pain scores at rest between the groups at this time point. At 24 hours, 48 hours, 1 week, 2 weeks, 6 weeks and 3 months after the surgery, the differences of median NRS pain scores during movement and at rest were not statistically significant. In terms of functional outcomes of the patients, postoperative DASH score, grip strength, and ROM of the PIP joint did not show statistically significant differences between the three treatment groups. The compliance of postoperative pain medication was assessed by the consumption of Ibuprofen which was similar between the Ketorolac with Ibuprofen group and the Ibuprofen alone group. As for the postoperative consumption of paracetamol as a rescue painkiller, there was no statistically significant difference between the groups. However, the Ketorolac alone group had the lowest consumption of paracetamol, suggesting that Ketorolac infiltration might have contributed to better pain control compared to the other groups. Regarding postoperative complications, there was no statistically significant difference between the groups. Only one case of numbness over the operated digit was reported in the Ketorolac with Ibuprofen group. There was an increased number of patients who had ecchymosis around surgical site in Ketorolac-receiving groups; however, there was no statistically significant difference between groups. Those minor complications were eventually resolved within 2 weeks. Discussion This is the first randomized controlled trial study comparing local NSAIDs infiltration with ketorolac to conventional oral painkillers in patients undergoing open trigger finger surgery. There was little available study about local infiltration with NSAID drugs in open trigger finger surgery. Most of the previous studies applied the treatment in major surgery. In a systematic review, it was found that ketorolac 30–60 mg appears to be an effective infiltration agent in non-orthopedic surgery, such as abdominal and gynecologic surgery, cesarean section, and breast surgery, with peripheral analgesia beyond the effects of systemic absorption. [ 8 ] One study compared the effectiveness of 60 mg of Ketorolac administered through local infiltration at surgical site versus its use in conjunction with intravenous regional anesthesia during ambulatory hand surgery. Results from the study showed advantages associated with local Ketorolac infiltration, including reduced pain scores, an extended period before first dose of rescuer pain medication ,and lower frequency of postoperative pain medication utilization.[ 15 ] The studies did not report any significant or severe complications. Thus, local Ketorolac infiltration is effective and can safely be used as an adjunctive analgesia for postoperative pain control. In this study, we applied local infiltration with 30 mg of Ketorolac before surgical wound closure. The main finding is that it could significantly reduce postoperative pain during finger movement at 6 hours after administration. We performed post hoc analysis to identify the difference between three groups. At 6 hours after surgery, the results of pain scores during finger movement showed statistically significant difference between the Ibuprofen alone group and the other groups that used local ketorolac infiltration. This can imply that local infiltration with ketorolac, with or without combining it with postoperative NSAID drugs, can effectively help reduce pain at the surgical site, especially in 6 hours after the surgery. In theory, the effect of pain relief by Ketorolac should be 8–10 hours, according to its half-life of 1.8 hours. Therefore, the results in this study corresponded to the characteristics of Ketorolac. Our results were comparable with previous studies that showed local wound infiltration with ketorolac helped with postoperative pain control.[ 9 – 12 , 14 , 15 ] Open trigger finger release surgery is considered a minor surgery. Postoperative pain might be lower than other major surgeries. Therefore, the pain score between groups might be too small to detect the clinically significant difference. When comparing the duration of pain control after local infiltration of Ketorolac to other research, the duration of pain control from our study was effective only for a shorter period. This might be because we used only 1 ml of 30 mg of ketorolac instead of combining it with local anesthetics such as Bupivacaine and lidocaine, which might prolong the duration of pain relief as found in other literatures. More research about the dose-response relationship and combination of Ketorolac to other drugs could be conducted to prolong the analgesic effect in trigger finger surgery. Some participants experienced dorsal PIP joint tenderness. According to Monteerarat Y., et al. mentioned that dorsal PIP joint tenderness is more common in trigger fingers and is associated with higher and prolonged postoperative pain after A1 pulley release.[ 16 ] To address potential confusion between pain at the surgical site and dorsal PIP pain, the assessors must thoroughly confirm the patients while evaluating the pain specifically over the A1 pulley area or the PIP joint pain. We also evaluated the functional outcomes of the participants using the DASH score, grip strength, and ROM of the PIP joint. However, the difference was too small to detect statistical significance between groups. Oral NSAIDs and local NSAIDs infiltration were equally effective in terms of the functional outcomes. The complications between the three groups were similar. This result was comparable to previous studies that found no evidence of serious complications.[ 8 , 10 – 12 ] We observed 12 participants who experienced ecchymosis around the surgical wound, with 6 participants in the Ketorolac with Ibuprofen group, which had the highest number among the three groups. However, there was no statistical significance between groups. All ecchymosis around surgical wounds were spontaneously resolved within 2 weeks without disturbing their functions. Conclusion Local infiltration of 30 mg of Ketorolac at the surgical site demonstrated advantage of pain control during finger movement within 6 hours after trigger finger release surgery compared to oral NSAIDs and is safe to be an alternative use for patients who have contraindications for systemic NSAIDs. Declarations Acknowledgements : The authors would like to acknowledge Mr. Pongsathorn Samphaotong and Miss Supani Duangkaew for their assistance with patient recruitment, data collection and analyzing the data. Author contributions statement : PL, TA and TV researched literature, developed the protocol, conceived the study, and analyzed the data. PL, TA, YM, RL and TV were involved in patient recruitment. PL and TA wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved its final version. Declaration of conflicting interests : The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Declaration of generative AI and AI - assisted technologies in the writing process : During the preparation of this work, the authors used ChatGPT 3.5 in order to improve language and readability purposes. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication. Funding : This research project is supported by Siriraj Research Fund, Grant Number R016531004, Faculty of Medicine Siriraj Hospital, Mahidol University. Consent to participate : Written informed consent was obtained from all subjects before the study . Consent for publication : The authors would like to declare that the study is original research that has not been published elsewhere and is not under consideration by another journal . All the authors have approved the enclosed manuscript . Availability of data and material : The datasets used or analyzed during the study are available from the corresponding author on reasonable request . Ethical approval : The ethical approval of this study was obtained from the Siriraj Institutional Review Board (Certificate of Approval no. Si 633/2021). Trial registration : This clinical trial was registered in the Thai Clinical Trials Registry ( TCTR ) on 25/08/2021 : register number TCTR20210825002 . https://www.thaiclinicaltrials.org/show/TCTR20210825002 References David M, Rangaraju M, Raine A. Acquired triggering of the fingers and thumb in adults. BMJ. 2017;359:j5285. Gil JA, Hresko AM, Weiss AC. Current Concepts in the Management of Trigger Finger in Adults. J Am Acad Orthop Surg. 2020;28(15):e642–50. Lunsford D, Valdes K, Hengy S. Conservative management of trigger finger: A systematic review. J Hand Ther. 2019;32(2):212–21. Bruijnzeel H, Neuhaus V, Fostvedt S, Jupiter JB, Mudgal CS, Ring DC. Adverse events of open A1 pulley release for idiopathic trigger finger. J Hand Surg Am. 2012;37(8):1650–6. Everding NG, Bishop GB, Belyea CM, Soong MC. Risk factors for complications of open trigger finger release. Hand (N Y). 2015;10(2):297–300. Will R, Lubahn J. Complications of open trigger finger release. J Hand Surg Am. 2010;35(4):594–6. Kelley BP, Shauver MJ, Chung KC. Management of Acute Postoperative Pain in Hand Surgery: A Systematic Review. J Hand Surg Am. 2015;40(8):1610. 9.e1. Bai JW, An D, Perlas A, Chan V. Adjuncts to local anesthetic wound infiltration for postoperative analgesia: a systematic review. Reg Anesth Pain Med. 2020;45(8):645–55. Andersen KV, Nikolajsen L, Haraldsted V, Odgaard A, Søballe K. Local infiltration analgesia for total knee arthroplasty: should ketorolac be added? Br J Anaesth. 2013;111(2):242–8. Chuckpaiwong B, Harnroongroj T, Sirivanasandha B, Tharmviboonsri T. Local Ketorolac Injection vs Popliteal Sciatic Nerve Blockade as an Adjuvant to a Spinal Block in Hindfoot Arthrodesis. Foot Ankle Int. 2021;42(5):570–4. Mahabir RC, Peterson BD, Williamson JS, Valnicek SM, Williamson DG, East WE. Locally administered ketorolac and bupivacaine for control of postoperative pain in breast augmentation patients. Plast Reconstr Surg. 2004;114(7):1910–6. Niemeläinen M, Kalliovalkama J, Aho AJ, Moilanen T, Eskelinen A. Single periarticular local infiltration analgesia reduces opiate consumption until 48 hours after total knee arthroplasty. A randomized placebo-controlled trial involving 56 patients. Acta Orthop. 2014;85(6):614–9. Leow MQH, Hay ASR, Ng SL, Choudhury MM, Li H, McGrouther DA, et al. A randomized controlled trial comparing ketorolac and triamcinolone injections in adults with trigger digits. J Hand Surg Eur Vol. 2018;43(9):936–41. Parker RK, Holtmann B, Smith I, White PF. Use of ketorolac after lower abdominal surgery. Effect on analgesic requirement and surgical outcome. Anesthesiology. 1994;80(1):6–12. Reuben SS, Duprat KM. Comparison of wound infiltration with ketorolac versus intravenous regional anesthesia with ketorolac for postoperative analgesia following ambulatory hand surgery. Reg Anesth. 1996;21(6):565–8. Monteerarat Y, Misen P, Laohaprasitiporn P, Wongsaengaroonsri P, Lektrakul N, Vathana T. Dorsal proximal interphalangeal joint tenderness is associated with prolonged postoperative pain after A1 pulley release for trigger fingers. BMC Musculoskelet Disord. 2023;24(1):13. Tables Table 1 Demographic data between groups Demographic data NSS + Ibuprofen (N=23) Ketorolac + Placebo (N=23) Ketorolac + Ibuprofen (N=23) p-value Age* (year) 58.5 (11.6) 54.5 (7.6) 58.2 (8) 0.281 a Female 18 (78%) 19 (83%) 17 (74%) 0.774 b BMI* (kg/m 2 ) 24.8 (4.3) 25.2 (6.5) 24.6 (4.5) 0.926 a Involved finger Thumb Index finger Middle finger Ring finger Small finger 8 (35%) 2 (8.5%) 11 (48%) 2 (8.5%) 0 11 (48%) 2 (8.5%) 8 (35%) 2 (8.5%) 0 7 (30.5%) 2 (8.5%) 9 (39%) 4 (17.5%) 1 (4.5%) 0.809 b Grading of trigger finger Grade 2 Grade 3 Grade 4 4 (17%) 10 (44%) 9 (39%) 6 (26%) 12 (52%) 5 (22%) 8 (35%) 12 (52%) 3 (13%) 0.302 b Pre-operative NRS pain at rest** 1 (0, 4) 1 (0, 3) 0 (0, 2) 0.502 c Pre-operative NRS pain during movement** 7 (5, 7.5) 7 (5, 8) 7 (3, 8.5) 0.838 c Pre-operative DASH score** 18.3 (11.7, 25.8) 23.3 (17.9, 30.9) 15 (9.2, 25.4) 0.180 c Pre-operative grip strength** (kg) 16 (12, 20.5) 18 (11.5, 20) 16 (9.5, 26) 0.996 c Pre-operative ROM of PIP joint** (degree) 77 (62.5, 95) 67 (37.5, 92.5) 85 (65, 92.5) 0.571 c Operative time** (min) 15 (10, 20) 20 (10, 20) 20 (10, 25) 0.329 c *Data were presented as mean and standard deviation (SD) **Data were presented as median and interquartile range a One-way ANOVA test; b Chi-square test ; c Kruskal-Wallis test BMI = body mass index; NRS = numerical rating scale; DASH = Disability of arm, shoulder ,and hand; ROM = range of motion; PIP = proximal interphalangeal Table 2 Postoperative outcomes between groups Postoperative Outcomes NSS + Ibuprofen (N=23) Ketorolac + placebo (N=23) Ketorolac + Ibuprofen (N=23) p-value NRS pain at rest* 6 hours 24 hours 48 hours 1 week 2 weeks 6 weeks 3 months 2 (1, 3) 1 (0, 1.5) 0 (0, 0) 0 (0, 0) 0 (0, 0) 0 (0, 0) 0 (0, 0) 1 (0.5, 2) 1 (0, 1) 0 (0, 1) 0 (0, 0) 0 (0, 0) 0 (0, 0) 0 (0, 0) 1 (0, 3) 2 (0, 2.5) 0 (0, 1) 0 (0, 0) 0 (0, 0) 0 (0, 0) 0 (0, 0) 0.166 0.901 0.164 0.3 0.059 0.352 0.362 NRS pain during finger movement* 6 hours 24 hours 48 hours 1 week 2 weeks 6 weeks 3 months 5 (4, 6) 3 (2, 6) 2 (1, 3) 2 (0.5, 3) 2 (1, 3.5) 1 (0, 1.5) 0 (0, 0) 3 (1.5, 3.5) 3 (1.5, 4) 2 (1, 2.5) 1 (0, 2.5) 1 (0.5, 2.5) 1 (0, 1.5) 0 (0, 1) 3 (1.5, 4.5) 3 (2, 4) 3 (1.5, 5) 1 (0, 3) 1 (0.5, 2) 1 (0, 2) 0 (0, 0) 0.001 0.487 0.235 0.926 0.465 0.846 0.128 DASH score* 1 week 6 weeks 3 months 11.7 (7.5, 20.2) 3.3 (1.7, 10) 1.3 (0, 1.7) 13.3 (11.7, 17.4) 8.3 (4.2, 10.4) 1.7 (1.3, 3) 13.3 (6.3, 19.4) 5.8 (1.7, 7.8) 1.7 (0, 2.1) 0.674 0.316 0.322 Grip strength* (kg) 1 week 6 weeks 3 months 10 (10, 15) 18 (14, 20.5) 21 (19, 24) 13 (9, 14) 16 (13, 20) 20 (18, 24) 12 (6, 20) 18 (14, 22) 22.5 (19, 28) 0.649 0.384 0.216 ROM of PIP joint* (degree) 1 week 6 weeks 3 months 75 (57.5, 85) 80 (65, 92.5) 95 (70, 100) 78 (52, 88) 95 (65, 100) 95 (70, 100) 84.5 (70, 95) 97.5 (70, 105) 105 (75, 108) 0.431 0.406 0.272 Complications Ecchymosis/Hematoma Numbness GI disturbance Wound dehiscence 2 (8.7%) 0 2 (8.7%) 0 4 (17.4%) 0 2 (8.7%) 1 (4.3%) 6 (26.1%) 1 (4.3%) 0 0 0.298 0.363 0.346 0.363 *Data were presented as median and interquartile range NRS = numerical rating scale; DASH = Disability of arm, shoulder ,and hand; ROM = range of motion; PIP = proximal interphalangeal; GI = Gastrointestinal Table 3 Post hoc analysis of NRS during finger movement at 6 hours postoperative period Group comparisons Mean difference p-value a 95% Confidence interval Lower bound Upper bound NSS + Ibuprofen VS Ketorolac alone 2.3 0.002 0.78 3.83 NSS + Ibuprofen VS Ketorolac + Ibuprofen 1.65 0.031 0.13 3.18 Ketorolac alone VS Ketorolac + Ibuprofen -0.65 0.564 -2.18 0.87 a Tukey’s Honest Significant Difference test NRS = numerical rating scale; NSS = normal saline solution Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Sep, 2024 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted Editorial decision: Revision requested 24 Jul, 2024 Reviews received at journal 23 Jul, 2024 Reviews received at journal 23 Jul, 2024 Reviewers agreed at journal 22 Jul, 2024 Reviewers agreed at journal 21 Jul, 2024 Reviewers agreed at journal 21 Jul, 2024 Reviewers agreed at journal 20 Jul, 2024 Reviews received at journal 20 Jul, 2024 Reviews received at journal 02 Jul, 2024 Reviewers agreed at journal 25 Jun, 2024 Reviewers agreed at journal 23 Jun, 2024 Reviewers invited by journal 23 Jun, 2024 Editor invited by journal 20 Jun, 2024 Editor assigned by journal 14 Jun, 2024 Submission checks completed at journal 14 Jun, 2024 First submitted to journal 08 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4550595","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":322430070,"identity":"9aae9ea8-6ac9-44d6-857f-63f439820dae","order_by":0,"name":"Thanat Auwattanamongkol","email":"","orcid":"","institution":"Mahidol university","correspondingAuthor":false,"prefix":"","firstName":"Thanat","middleName":"","lastName":"Auwattanamongkol","suffix":""},{"id":322430071,"identity":"2f6eff38-313d-4d1a-b9d0-9a629d9a8c16","order_by":1,"name":"Panai Laohaprasitiporn","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYLCCBAYLBgb2BgZmBgNmBj6ggAQRWoBqeA5AtLARpQWsRiIBqIWBCC3m7GcPfnjAICHPL/k68XNBgbUcGwPzwds8eLRY9uQlA82XMJw5O3ez9AyDdGM2BrZka3xaDA7kGIC0MG64nbtBmsfgcGIbA4+ZNF4t598Y/wBqsd9w8+zm3xAt/N/wa7mRYwayJXHDDd5tMFvY8GqxnPHGzCLBQCJ5Zk/uNmsekF+Y2Ywt5+DRYs6fY3zzR4WNbT/72c23ef5Yy/GzNz+88Qafw5BIKGDGoxxD8SgYBaNgFIwCrAAArn1AbNd+qeIAAAAASUVORK5CYII=","orcid":"","institution":"Mahidol university","correspondingAuthor":true,"prefix":"","firstName":"Panai","middleName":"","lastName":"Laohaprasitiporn","suffix":""},{"id":322430072,"identity":"2995ff7a-8ef6-45a9-9daf-d075c889ec5f","order_by":2,"name":"Yuwarat Monteerarat","email":"","orcid":"","institution":"Mahidol university","correspondingAuthor":false,"prefix":"","firstName":"Yuwarat","middleName":"","lastName":"Monteerarat","suffix":""},{"id":322430073,"identity":"664b518b-4d1f-432b-bd4a-20a41e621ac8","order_by":3,"name":"Roongsak Limthongthang","email":"","orcid":"","institution":"Mahidol university","correspondingAuthor":false,"prefix":"","firstName":"Roongsak","middleName":"","lastName":"Limthongthang","suffix":""},{"id":322430074,"identity":"11317661-52e1-40a9-92c1-62fceb0d0f80","order_by":4,"name":"Torpon Vathana","email":"","orcid":"","institution":"Mahidol university","correspondingAuthor":false,"prefix":"","firstName":"Torpon","middleName":"","lastName":"Vathana","suffix":""}],"badges":[],"createdAt":"2024-06-08 12:33:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4550595/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4550595/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12891-024-07856-6","type":"published","date":"2024-09-17T15:57:07+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60432552,"identity":"cbfabe5d-164b-403a-b629-cbc9d5bb03e2","added_by":"auto","created_at":"2024-07-16 16:53:58","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":438547,"visible":true,"origin":"","legend":"\u003cp\u003eThe Consolidated Standards of Reporting Trials (CONSORT) flow diagram\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4550595/v1/05b9816031bdd6da22195f10.jpg"},{"id":65103915,"identity":"3dbe7f3b-7d8e-4ae7-ab0a-eb7ddae8c31c","added_by":"auto","created_at":"2024-09-23 16:09:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1233658,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4550595/v1/5930d528-21b9-45ed-950f-ad23e4ebe4a4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Local Ketorolac Infiltration for Postoperative Pain in Open Trigger Finger Surgery: A Randomized Controlled Trial","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTrigger finger is a prevalent condition affecting the upper extremities in adult patients. Its occurrence is quite common, with an annual incidence rate of 28 cases per 100,000 individuals in the adult population.[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Typically, patients suffering from trigger finger experience pain or a clicking sensation near the metacarpal head level of the hand. These symptoms can lead to difficulties in holding objects or grasping items effectively.[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOne of the treatment options available for patients with trigger finger is surgical intervention, which includes open release and percutaneous release of the A1 pulley. The success rate for open release of the A1 pulley ranges from 90\u0026ndash;100%.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] However, it is important to note that a small percentage (approximately 5\u0026ndash;12%) of patients who undergo open surgical treatment may experience postoperative complications or prolonged symptoms.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] These symptoms may include snapping, locking, or pain even after the surgery has been performed. Approximately 19% of patients may continue to experience these symptoms for more than 8 weeks after the surgical procedure.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] The persistence of prolonged postoperative symptoms can lead to patient dissatisfaction and may also hinder the ability to perform daily activities, impacting the patient's overall quality of life. Therefore, careful consideration and monitoring of patients after surgical treatment for trigger finger are crucial to address any potential complications and ensure optimal outcomes.\u003c/p\u003e \u003cp\u003eMultimodal analgesic drugs play a pivotal role in managing postoperative pain, even in minor hand surgeries.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Among the commonly prescribed medications for postoperative pain control in open trigger finger release, paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used. In contrast, opioids are rarely employed for pain management in minor surgical procedures. To provide local pain control after surgery, some surgeons have adopted the approach of administering analgesic drugs through local infiltration at the surgical site. This localized method of pain management can help alleviate discomfort and enhance patient recovery following the procedure.\u003c/p\u003e \u003cp\u003eKetorolac is an intravenous NSAID commonly prescribed for short-term postoperative pain control. Its unique properties make it nonirritating to human tissue, and its pKa of 3.5 enables it to concentrate in injured and inflamed tissues.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Due to these characteristics, ketorolac can be effectively used as a local infiltration at the surgical wound site, thereby enhancing postoperative pain control. Studies have shown that local infiltration of 30\u0026ndash;60 mg of ketorolac has proven effective for providing local analgesia with minimal systemic absorption.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Moreover, research has indicated that ketorolac can effectively reduce early postoperative pain in various surgical procedures, including hindfoot arthrodesis, primary breast augmentation, and total knee arthroplasty.[\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Notably, using ketorolac as a local infiltration drug has demonstrated safety, with no evidence of serious complications reported in studies.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] This makes ketorolac a viable option for enhancing postoperative pain control without undue risk of adverse effects.\u003c/p\u003e \u003cp\u003eThe current evidence regarding local ketorolac infiltration for postoperative pain control in hand surgery is limited. Therefore, the objective of this randomized controlled study is to assess the effectiveness of local ketorolac infiltration as compared to conventional oral NSAIDs in managing postoperative pain in patients who have undergone open trigger finger surgery.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003e The study protocol underwent a thorough review and received approval from the Institutional Review Board of research involving human subjects. This study was performed in accordance with the Declaration of Helsinki and reported according to Consolidated Standards of Reporting Trials (CONSORT). Additionally, this research protocol was registered in the Clinical Trials Registry database to ensure transparency and adherence to ethical standards. Before enrolling in the study, all eligible participants were provided with comprehensive information about the study, its objectives, potential risks, and benefits. Informed consent was obtained from each participant, indicating their voluntary decision to participate in the research after fully understanding its implications.\u003c/p\u003e \u003cp\u003e This study was a parallel design, randomized controlled trial and conducted at a tertiary care hospital from December 2021 to October 2022. The study focused on patients who underwent open trigger finger release on a single digit, with the procedure performed under local anesthesia. We included patients aged between 18 and 75 years old and presenting with a Quinell grade 2\u0026ndash;4 single trigger digit. Patients who met any of the exclusion criteria were not included in the study. The exclusion criteria encompassed patients who had undergone prior trigger finger release in the same digit, had recurrent trigger finger, had congenital trigger finger, had experienced a fracture or tendon injury on the target digit, had inflammatory joint diseases (e.g., rheumatoid arthritis or gouty arthritis), had concomitant ipsilateral carpal tunnel syndrome and/or de Quervain's disease, had a known history of hypersensitivity to NSAIDs, had concomitant diseases that contraindicated the use of NSAIDs (e.g., chronic kidney disease stage 3, gastric ulcer, gastroesophageal reflux disease, history of gastrointestinal bleeding, coronary artery disease, cerebrovascular disease, etc.), or were pregnant or breastfeeding women.\u003c/p\u003e \u003cp\u003eThe participants in this study were randomly assigned to one of three treatment groups using a computerized randomization process in blocks of six. The results of the randomization were placed in opaque envelopes and remained sealed until the patient was positioned on the operating table. The trial drugs were also packaged within these sealed envelopes.\u003c/p\u003e \u003cp\u003ePatients in the Ibuprofen alone group received a local injection of 1 ml of normal saline solution (NSS) before the surgical wound closure, and they were prescribed 400 mg of Ibuprofen in the form of 2 capsules, to be taken three times per day for 5 days. Patients in the Ketorolac alone group were locally injected with 1 ml of Ketorolac (30mg/ml) before surgical wound closure, and for postoperative pain management, they received oral placebo in the form of 2 capsules, to be taken three times per day for 5 days. Patients in the Ketorolac with Ibuprofen group were treated with a 1 ml injection of Ketorolac (30mg/ml) before the surgical wound closure, and they were prescribed 400 mg of Ibuprofen in the form of 2 capsules, to be taken three times per day for 5 days.\u003c/p\u003e \u003cp\u003eIn this clinical trial, a 1 ml injection of Ketorolac was used as one of the treatment drugs. This Ketorolac injection was odorless and colorless, and its appearance was indistinguishable from normal saline. To ensure blinding in the study, the Ibuprofen tablets for postoperative pain control were encapsulated in white capsules, making them visually indistinguishable from other drugs. Participants in the Ketorolac alone group received a placebo drug, which was a white capsule containing medical starch. Both the Ibuprofen capsule and the placebo capsule were made to look identical, further supporting the blinding process.\u003c/p\u003e \u003cp\u003eThis clinical trial was conducted as a double-blinded study. The patients participating in the study were not informed about which drugs they received during the trial. Additionally, the surgeon who performed the trigger finger release procedures remained unaware of the specific drug assigned to each patient, either for injection before the operation or for postoperative medications. To eliminate potential biases, a trained research coordinator was responsible for carrying out all assessments and data collection.\u003c/p\u003e \u003cp\u003eThe primary outcome of this study was the pain score, which was assessed using the numeric rating scale (NRS) at 48 hours after the trigger finger surgery. The secondary outcomes included the Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, range of motion (ROM) of the proximal interphalangeal (PIP) joint of the affected finger and complications that arose as a result of the treatment interventions were recorded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy protocol and surgical technique\u003c/h2\u003e \u003cp\u003eBefore the operation, participants underwent a comprehensive assessment that included interviews and preoperative examinations to collect various types of data which included preoperative NRS pain score, ROM of PIP joint of the affected finger, grip strength, and DASH score.\u003c/p\u003e \u003cp\u003eIn the operating room, the patients were positioned on the operating table with the operating arm extended. The surgical site was prepared and draped with a surgical towel to maintain a sterile environment. The patient's view of the surgical field was obstructed by the surgical draping to maintain blinding during the procedure. A tourniquet was applied to the proximal forearm to control blood flow during the surgery. The surgeon then administered 4 ml of 1% lidocaine without adrenaline for local anesthesia at the surgical site. Once the anesthesia was effective, a 1-cm longitudinal skin incision was made, followed by a longitudinal complete release of the A1 pulley. Before closing the skin, the assistant nurse opened the sealed envelope containing the specific drug assigned to the participant's treatment group as per randomization. This process was concealed from the surgeon to maintain blinding. The assistant nurse prepared the injection drug, using a 27-Gauge needle and 3 ml syringe. Then, 1 ml of Ketorolac or 1 ml of NSS was injected into subcutaneous tissue of the surgical site. The tourniquet was then removed. After checking for any bleeding and suturing the skin with Nylon 4\u0026thinsp;\u0026minus;\u0026thinsp;0, the surgical wound was covered with sterile dressing.\u003c/p\u003e \u003cp\u003eIn all treatment groups, patients were prescribed with a standard medication regimen to manage their postoperative care. This included 500 mg of paracetamol, which could be taken as needed every 6 hours to alleviate pain and discomfort. All participants were given 20 mg of omeprazole once a day for 5 days. Along with the standard medications mentioned above, patients in Ibuprofen group and Ketorolac with Ibuprofen group were administered 400 mg of Ibuprofen in the form of 2 capsules, to be taken three times per day for 5 days. For Ketorolac alone group, placebo capsules were prescribed and to be taken three times per day for 5 days.\u003c/p\u003e \u003cp\u003eDuring the postoperative period, pain scores were assessed at specific time points. At 6 hours, 24 hours, and 48 hours after the surgery, participants were contacted by phone and asked to provide pain scores at the surgical site using the numeric rating scale (NRS), rating from 0 (no pain) to 10 (the worst pain imaginable). Participants' compliance with the prescribed medications was also recorded. This involved tracking the total number of Ibuprofen or placebo capsules and paracetamol tablets that the participants had taken up to each specific time point. Furthermore, any complications experienced by the participants were carefully monitored and documented. These complications included local bruising, hematoma, wound dehiscence, finger numbness, and surgical site infection.\u003c/p\u003e \u003cp\u003eAfter the trigger finger surgery, participants were scheduled to visit for postoperative checkups. These visits occurred at 1 week, 6 weeks, and 3 months after the operation. During the first week visit, the surgical wound was assessed, and the stitches were completely removed. Participants' pain score, ROM of PIP joint using digital goniometer, grip strength using Jamar handgrip dynamometer, DASH score, and any complications experienced were collected and recorded at each visit. Additionally, participants were contacted by phone 2 weeks after the operation to inquire about their pain score.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSample size calculation\u003c/h2\u003e \u003cp\u003eThe effect size of this study was determined from mean and standard deviation from each group. Sample size calculation was done using repeated measures ANOVA test to detect difference between treatment groups. Fifty-seven participants were required to detect the effect size of 0.376 with 90% statistical power and a significance level of 0.05. A twenty percent drop-out rate was expected in this study; therefore, a total of 69 participants were required for this study and randomly selected into 3 groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables were presented as mean and standard deviation when the data followed a normal distribution, or median and interquartile range when the data exhibited a nonnormal distribution. The Kruskal-Wallis analysis of variance (ANOVA) test was used to compare differences in continuous variables among groups if the data did not conform to a normal distribution. Categorical variables were presented as percentage and compared between groups using Chi-square test or Fisher\u0026rsquo;s exact test. Post hoc analysis of postoperative NRS was analyzed using Tukey\u0026rsquo;s Honest test to identify significant differences between groups. The p-values of \u0026lt;\u0026thinsp;0.05 were considered statistically significant. This study was conducted utilizing an intention-to-treat analysis approach.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 90 patients with trigger finger were screened for eligibility between December 2021 and December 2022.\u0026nbsp;Among them, 21 patients were excluded from the study based on the predefined exclusion criteria.\u0026nbsp;One patient was planned for single digit trigger finger surgery but later changed the operation to multiple trigger finger surgery.\u0026nbsp;Two patients were allergic to NSAIDs.\u0026nbsp;Two patients had other disorders on the same hand.\u0026nbsp;We excluded 14 patients who had contraindication to use NSAIDs.\u0026nbsp;As a result, a total of 69 eligible patients were enrolled and randomly assigned into three groups.\u0026nbsp;All groups equally consisted of 23 patients.\u0026nbsp;The CONSORT flow diagram of this study was shown in Figure 1.\u003c/p\u003e\n\u003cp\u003eThe baseline characteristics of participants in each treatment group are summarized in Table 1.\u0026nbsp;Overall, the characteristics were similar between the three groups.\u0026nbsp;Most of the participants were male, constituting the majority in each group.\u0026nbsp;The dominant hand of the participants was predominantly right-handed across all groups.\u0026nbsp;The severity of trigger finger, classified by the Quinell grading system, showed no significant differences between the groups.\u0026nbsp;However, most patients in all groups had Quinell grade 3 trigger finger.\u0026nbsp;Preoperative pain scores at rest and during finger movement were comparable between the groups, with no significant differences observed.\u0026nbsp;The preoperative status of the affected digit, as assessed by ROM of the PIP joint and grip strength, was also similar across the three groups.\u003c/p\u003e\n\u003cp\u003eThe postoperative pain evaluation results are presented in Table 2.\u0026nbsp;The NRS pain scores during movement at 6 hours after the surgery were significantly different between the groups\u0026nbsp;(p-value\u0026nbsp;=\u0026nbsp;0.001).\u0026nbsp;At 6 hours after surgery, the median NRS pain scores during movement in the Ketorolac alone group and ketorolac with Ibuprofen group were lower compared to the Ibuprofen alone group.\u0026nbsp;When comparing the NRS pain scores during movement at 6 hours after surgery between the Ketorolac with Ibuprofen group and the Ketorolac alone group through post hoc analysis, it was found that the Ibuprofen alone group had significantly higher pain score compared to the Ketorolac with Ibuprofen group and Ketorolac alone group\u0026nbsp;(Table 3).\u0026nbsp;At 6 hours after surgery,\u0026nbsp;the median pain score at rest of Ibuprofen alone group was higher compared to the other two groups.\u0026nbsp;However, there was no statistically significant difference in pain scores at rest between the groups at this time point.\u0026nbsp;At 24 hours, 48 hours, 1 week, 2 weeks, 6 weeks and 3 months after the surgery, the differences of median NRS pain scores during movement and at rest were not statistically significant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn terms of functional outcomes of the patients, postoperative DASH score, grip strength, and ROM of the PIP joint did not show statistically significant differences between the three treatment groups.\u003c/p\u003e\n\u003cp\u003eThe compliance of postoperative pain medication was assessed by the consumption of Ibuprofen which was similar between the Ketorolac with Ibuprofen group and the Ibuprofen alone group.\u0026nbsp;As for the postoperative consumption of paracetamol as a rescue painkiller, there was no statistically significant difference between the groups.\u0026nbsp;However, the Ketorolac alone group had the lowest consumption of paracetamol, suggesting that Ketorolac infiltration might have contributed to better pain control compared to the other groups.\u003c/p\u003e\n\u003cp\u003eRegarding postoperative complications, there was no statistically significant difference between the groups. Only one case of numbness over the operated digit was reported in the Ketorolac with Ibuprofen group. There was an increased number of patients who had ecchymosis around surgical site in Ketorolac-receiving groups; however, there was no statistically significant difference between groups. \u0026nbsp;Those minor complications were eventually resolved \u0026nbsp;within 2 weeks.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis is the first randomized controlled trial study comparing local NSAIDs infiltration with ketorolac to conventional oral painkillers in patients undergoing open trigger finger surgery. There was little available study about local infiltration with NSAID drugs in open trigger finger surgery. Most of the previous studies applied the treatment in major surgery. In a systematic review, it was found that ketorolac 30\u0026ndash;60 mg appears to be an effective infiltration agent in non-orthopedic surgery, such as abdominal and gynecologic surgery, cesarean section, and breast surgery, with peripheral analgesia beyond the effects of systemic absorption. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] One study compared the effectiveness of 60 mg of Ketorolac administered through local infiltration at surgical site versus its use in conjunction with intravenous regional anesthesia during ambulatory hand surgery. Results from the study showed advantages associated with local Ketorolac infiltration, including reduced pain scores, an extended period before first dose of rescuer pain medication ,and lower frequency of postoperative pain medication utilization.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] The studies did not report any significant or severe complications. Thus, local Ketorolac infiltration is effective and can safely be used as an adjunctive analgesia for postoperative pain control.\u003c/p\u003e \u003cp\u003eIn this study, we applied local infiltration with 30 mg of Ketorolac before surgical wound closure. The main finding is that it could significantly reduce postoperative pain during finger movement at 6 hours after administration. We performed post hoc analysis to identify the difference between three groups. At 6 hours after surgery, the results of pain scores during finger movement showed statistically significant difference between the Ibuprofen alone group and the other groups that used local ketorolac infiltration. This can imply that local infiltration with ketorolac, with or without combining it with postoperative NSAID drugs, can effectively help reduce pain at the surgical site, especially in 6 hours after the surgery. In theory, the effect of pain relief by Ketorolac should be 8\u0026ndash;10 hours, according to its half-life of 1.8 hours. Therefore, the results in this study corresponded to the characteristics of Ketorolac. Our results were comparable with previous studies that showed local wound infiltration with ketorolac helped with postoperative pain control.[\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOpen trigger finger release surgery is considered a minor surgery. Postoperative pain might be lower than other major surgeries. Therefore, the pain score between groups might be too small to detect the clinically significant difference. When comparing the duration of pain control after local infiltration of Ketorolac to other research, the duration of pain control from our study was effective only for a shorter period. This might be because we used only 1 ml of 30 mg of ketorolac instead of combining it with local anesthetics such as Bupivacaine and lidocaine, which might prolong the duration of pain relief as found in other literatures. More research about the dose-response relationship and combination of Ketorolac to other drugs could be conducted to prolong the analgesic effect in trigger finger surgery.\u003c/p\u003e \u003cp\u003eSome participants experienced dorsal PIP joint tenderness. According to Monteerarat Y., et al. mentioned that dorsal PIP joint tenderness is more common in trigger fingers and is associated with higher and prolonged postoperative pain after A1 pulley release.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] To address potential confusion between pain at the surgical site and dorsal PIP pain, the assessors must thoroughly confirm the patients while evaluating the pain specifically over the A1 pulley area or the PIP joint pain.\u003c/p\u003e \u003cp\u003eWe also evaluated the functional outcomes of the participants using the DASH score, grip strength, and ROM of the PIP joint. However, the difference was too small to detect statistical significance between groups. Oral NSAIDs and local NSAIDs infiltration were equally effective in terms of the functional outcomes.\u003c/p\u003e \u003cp\u003eThe complications between the three groups were similar. This result was comparable to previous studies that found no evidence of serious complications.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] We observed 12 participants who experienced ecchymosis around the surgical wound, with 6 participants in the Ketorolac with Ibuprofen group, which had the highest number among the three groups. However, there was no statistical significance between groups. All ecchymosis around surgical wounds were spontaneously resolved within 2 weeks without disturbing their functions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eLocal infiltration of 30 mg of Ketorolac at the surgical site demonstrated advantage of pain control during finger movement within 6 hours after trigger finger release surgery compared to oral NSAIDs and is safe to be an alternative use for patients who have contraindications for systemic NSAIDs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e The authors would like to acknowledge\u0026nbsp;Mr.\u0026nbsp;Pongsathorn Samphaotong\u0026nbsp;and Miss Supani Duangkaew for their assistance with patient recruitment, data collection and analyzing the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions statement\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e PL, TA and TV researched literature, developed the protocol, conceived the study, and analyzed the data.\u0026nbsp;PL, TA, YM, RL and TV were involved in patient recruitment.\u0026nbsp;PL and TA wrote the first draft of the manuscript.\u0026nbsp;All authors reviewed and edited the manuscript and approved its final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of conflicting interests\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThe authors declare no potential conflicts of interest with respect to the research, authorship,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eand/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of generative AI and AI\u003c/strong\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003cstrong\u003eassisted technologies in the writing process\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e During the preparation of this work, the authors used ChatGPT 3.5 in order to improve language and readability purposes.\u0026nbsp;After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThis research project is supported by Siriraj Research Fund, Grant Number R016531004, Faculty of Medicine Siriraj Hospital, Mahidol University.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e\u0026nbsp;Written informed consent was obtained from all subjects before the study\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThe authors would like to declare that the study is original research that has not been published elsewhere and is not under consideration by another journal\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eAll the authors have approved the enclosed manuscript\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThe datasets used or analyzed during the study are available from the corresponding author on reasonable request\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e The ethical approval of this study was obtained from the Siriraj Institutional Review Board\u0026nbsp;(Certificate of Approval no.\u0026nbsp;Si 633/2021).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eTrial registration\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/em\u003e\u003cem\u003eThis clinical trial was registered in the Thai Clinical Trials Registry\u0026nbsp;\u003c/em\u003e\u003cem\u003e\u003cstrong\u003e(\u003c/strong\u003e\u003c/em\u003e\u003cem\u003eTCTR\u003c/em\u003e\u003cem\u003e\u003cstrong\u003e)\u0026nbsp;\u003c/strong\u003e\u003c/em\u003e\u003cem\u003eon\u0026nbsp;\u003c/em\u003e25/08/2021\u003cem\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e\u003c/em\u003e\u003cem\u003eregister number TCTR20210825002\u003c/em\u003e\u003cem\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/em\u003e https://www.thaiclinicaltrials.org/show/TCTR20210825002\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDavid M, Rangaraju M, Raine A. Acquired triggering of the fingers and thumb in adults. BMJ. 2017;359:j5285.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGil JA, Hresko AM, Weiss AC. Current Concepts in the Management of Trigger Finger in Adults. J Am Acad Orthop Surg. 2020;28(15):e642\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLunsford D, Valdes K, Hengy S. Conservative management of trigger finger: A systematic review. J Hand Ther. 2019;32(2):212\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBruijnzeel H, Neuhaus V, Fostvedt S, Jupiter JB, Mudgal CS, Ring DC. Adverse events of open A1 pulley release for idiopathic trigger finger. J Hand Surg Am. 2012;37(8):1650\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEverding NG, Bishop GB, Belyea CM, Soong MC. Risk factors for complications of open trigger finger release. Hand (N Y). 2015;10(2):297\u0026ndash;300.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWill R, Lubahn J. Complications of open trigger finger release. J Hand Surg Am. 2010;35(4):594\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelley BP, Shauver MJ, Chung KC. Management of Acute Postoperative Pain in Hand Surgery: A Systematic Review. J Hand Surg Am. 2015;40(8):1610. 9.e1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBai JW, An D, Perlas A, Chan V. Adjuncts to local anesthetic wound infiltration for postoperative analgesia: a systematic review. Reg Anesth Pain Med. 2020;45(8):645\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAndersen KV, Nikolajsen L, Haraldsted V, Odgaard A, S\u0026oslash;balle K. Local infiltration analgesia for total knee arthroplasty: should ketorolac be added? Br J Anaesth. 2013;111(2):242\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChuckpaiwong B, Harnroongroj T, Sirivanasandha B, Tharmviboonsri T. Local Ketorolac Injection vs Popliteal Sciatic Nerve Blockade as an Adjuvant to a Spinal Block in Hindfoot Arthrodesis. Foot Ankle Int. 2021;42(5):570\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahabir RC, Peterson BD, Williamson JS, Valnicek SM, Williamson DG, East WE. Locally administered ketorolac and bupivacaine for control of postoperative pain in breast augmentation patients. Plast Reconstr Surg. 2004;114(7):1910\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNiemel\u0026auml;inen M, Kalliovalkama J, Aho AJ, Moilanen T, Eskelinen A. Single periarticular local infiltration analgesia reduces opiate consumption until 48 hours after total knee arthroplasty. A randomized placebo-controlled trial involving 56 patients. Acta Orthop. 2014;85(6):614\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeow MQH, Hay ASR, Ng SL, Choudhury MM, Li H, McGrouther DA, et al. A randomized controlled trial comparing ketorolac and triamcinolone injections in adults with trigger digits. J Hand Surg Eur Vol. 2018;43(9):936\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParker RK, Holtmann B, Smith I, White PF. Use of ketorolac after lower abdominal surgery. Effect on analgesic requirement and surgical outcome. Anesthesiology. 1994;80(1):6\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReuben SS, Duprat KM. Comparison of wound infiltration with ketorolac versus intravenous regional anesthesia with ketorolac for postoperative analgesia following ambulatory hand surgery. Reg Anesth. 1996;21(6):565\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMonteerarat Y, Misen P, Laohaprasitiporn P, Wongsaengaroonsri P, Lektrakul N, Vathana T. Dorsal proximal interphalangeal joint tenderness is associated with prolonged postoperative pain after A1 pulley release for trigger fingers. BMC Musculoskelet Disord. 2023;24(1):13.\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eDemographic data between groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"666\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.03603603603604%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNSS + Ibuprofen\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;(N=23)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.117117117117118%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKetorolac + Placebo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=23)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKetorolac + Ibuprofen\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=23)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.612612612612613%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.03603603603604%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge* (year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e58.5 (11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.117117117117118%\" valign=\"top\"\u003e\n \u003cp\u003e54.5 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\" valign=\"top\"\u003e\n \u003cp\u003e58.2 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.612612612612613%\" valign=\"top\"\u003e\n \u003cp\u003e0.281\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.03603603603604%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e18 (78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.117117117117118%\" valign=\"top\"\u003e\n \u003cp\u003e19 (83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\" valign=\"top\"\u003e\n \u003cp\u003e17 (74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.612612612612613%\" valign=\"top\"\u003e\n \u003cp\u003e0.774\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.03603603603604%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI* (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e24.8 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.117117117117118%\" valign=\"top\"\u003e\n \u003cp\u003e25.2 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\" valign=\"top\"\u003e\n \u003cp\u003e24.6 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.612612612612613%\" valign=\"top\"\u003e\n \u003cp\u003e0.926\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.03603603603604%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInvolved finger\u003c/strong\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eThumb\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eIndex finger\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMiddle finger\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eRing finger\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSmall finger\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (35%)\u003c/p\u003e\n \u003cp\u003e2 (8.5%)\u003c/p\u003e\n \u003cp\u003e11 (48%)\u003c/p\u003e\n \u003cp\u003e2 (8.5%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.117117117117118%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (48%)\u003c/p\u003e\n \u003cp\u003e2 (8.5%)\u003c/p\u003e\n \u003cp\u003e8 (35%)\u003c/p\u003e\n \u003cp\u003e2 (8.5%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (30.5%)\u003c/p\u003e\n \u003cp\u003e2 (8.5%)\u003c/p\u003e\n \u003cp\u003e9 (39%)\u003c/p\u003e\n \u003cp\u003e4 (17.5%)\u003c/p\u003e\n \u003cp\u003e1 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.612612612612613%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.809\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.03603603603604%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrading of trigger finger\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eGrade 2\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eGrade 3\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eGrade 4\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (17%)\u003c/p\u003e\n \u003cp\u003e10 (44%)\u003c/p\u003e\n \u003cp\u003e9 (39%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.117117117117118%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (26%)\u003c/p\u003e\n \u003cp\u003e12 (52%)\u003c/p\u003e\n \u003cp\u003e5 (22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (35%)\u003c/p\u003e\n \u003cp\u003e12 (52%)\u003c/p\u003e\n \u003cp\u003e3 (13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.612612612612613%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.302\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.03603603603604%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-operative NRS pain at rest**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0, 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.117117117117118%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0, 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0, 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.612612612612613%\" valign=\"top\"\u003e\n \u003cp\u003e0.502\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.03603603603604%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-operative NRS pain during movement**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e7 (5, 7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.117117117117118%\" valign=\"top\"\u003e\n \u003cp\u003e7 (5, 8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\" valign=\"top\"\u003e\n \u003cp\u003e7 (3, 8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.612612612612613%\" valign=\"top\"\u003e\n \u003cp\u003e0.838\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.03603603603604%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-operative DASH score**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e18.3 (11.7, 25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.117117117117118%\" valign=\"top\"\u003e\n \u003cp\u003e23.3 (17.9, 30.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\" valign=\"top\"\u003e\n \u003cp\u003e15 (9.2, 25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.612612612612613%\" valign=\"top\"\u003e\n \u003cp\u003e0.180\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.03603603603604%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-operative grip strength** (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e16 (12, 20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.117117117117118%\" valign=\"top\"\u003e\n \u003cp\u003e18 (11.5, 20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\" valign=\"top\"\u003e\n \u003cp\u003e16 (9.5, 26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.612612612612613%\" valign=\"top\"\u003e\n \u003cp\u003e0.996\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.03603603603604%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-operative ROM of PIP joint** (degree)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e77 (62.5, 95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.117117117117118%\" valign=\"top\"\u003e\n \u003cp\u003e67 (37.5, 92.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\" valign=\"top\"\u003e\n \u003cp\u003e85 (65, 92.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.612612612612613%\" valign=\"top\"\u003e\n \u003cp\u003e0.571\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.03603603603604%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperative time** (min)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e15 (10, 20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.117117117117118%\" valign=\"top\"\u003e\n \u003cp\u003e20 (10, 20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\" valign=\"top\"\u003e\n \u003cp\u003e20 (10, 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.612612612612613%\" valign=\"top\"\u003e\n \u003cp\u003e0.329\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Data were presented as mean and standard deviation (SD)\u003c/p\u003e\n\u003cp\u003e**Data were presented as median and interquartile range\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eOne-way ANOVA test; \u003csup\u003eb\u0026nbsp;\u003c/sup\u003eChi-square test\u003csup\u003e\u0026nbsp;\u003c/sup\u003e; \u003csup\u003ec\u003c/sup\u003e Kruskal-Wallis test\u003c/p\u003e\n\u003cp\u003eBMI = body mass index; NRS = numerical rating scale; DASH = Disability of arm, shoulder ,and hand; ROM = range of motion; PIP = proximal interphalangeal \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003ePostoperative outcomes between groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.818181818181817%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative Outcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNSS + Ibuprofen\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=23)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.181818181818183%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKetorolac + placebo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=23)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKetorolac + Ibuprofen\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=23)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.818181818181818%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.818181818181817%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNRS pain at rest*\u003c/strong\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e6 hours\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e24 hours\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e48 hours\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e1 week\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e2 weeks\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e6 weeks\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e3 months\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (1, 3)\u003c/p\u003e\n \u003cp\u003e1 (0, 1.5)\u003c/p\u003e\n \u003cp\u003e0 (0, 0)\u003c/p\u003e\n \u003cp\u003e0 (0, 0)\u003c/p\u003e\n \u003cp\u003e0 (0, 0)\u003c/p\u003e\n \u003cp\u003e0 (0, 0)\u003c/p\u003e\n \u003cp\u003e0 (0, 0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.181818181818183%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (0.5, 2)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;1 (0, 1)\u003c/p\u003e\n \u003cp\u003e0 (0, 1)\u003c/p\u003e\n \u003cp\u003e0 (0, 0)\u003c/p\u003e\n \u003cp\u003e0 (0, 0)\u003c/p\u003e\n \u003cp\u003e0 (0, 0)\u003c/p\u003e\n \u003cp\u003e0 (0, 0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (0, 3)\u003c/p\u003e\n \u003cp\u003e2 (0, 2.5)\u003c/p\u003e\n \u003cp\u003e0 (0, 1)\u003c/p\u003e\n \u003cp\u003e0 (0, 0)\u003c/p\u003e\n \u003cp\u003e0 (0, 0)\u003c/p\u003e\n \u003cp\u003e0 (0, 0)\u003c/p\u003e\n \u003cp\u003e0 (0, 0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.818181818181818%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.166\u003c/p\u003e\n \u003cp\u003e0.901\u003c/p\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003cp\u003e0.352\u003c/p\u003e\n \u003cp\u003e0.362\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.818181818181817%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNRS pain during finger movement*\u003c/strong\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e6 hours\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e24 hours\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e48 hours\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e1 week\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e2 weeks\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e6 weeks\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e3 months\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (4, 6)\u003c/p\u003e\n \u003cp\u003e3 (2, 6)\u003c/p\u003e\n \u003cp\u003e2 (1, 3)\u003c/p\u003e\n \u003cp\u003e2 (0.5, 3)\u003c/p\u003e\n \u003cp\u003e2 (1, 3.5)\u003c/p\u003e\n \u003cp\u003e1 (0, 1.5)\u003c/p\u003e\n \u003cp\u003e0 (0, 0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.181818181818183%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (1.5, 3.5)\u003c/p\u003e\n \u003cp\u003e3 (1.5, 4)\u003c/p\u003e\n \u003cp\u003e2 (1, 2.5)\u003c/p\u003e\n \u003cp\u003e1 (0, 2.5)\u003c/p\u003e\n \u003cp\u003e1 (0.5, 2.5)\u003c/p\u003e\n \u003cp\u003e1 (0, 1.5)\u003c/p\u003e\n \u003cp\u003e0 (0, 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (1.5, 4.5)\u003c/p\u003e\n \u003cp\u003e3 (2, 4)\u003c/p\u003e\n \u003cp\u003e3 (1.5, 5)\u003c/p\u003e\n \u003cp\u003e1 (0, 3)\u003c/p\u003e\n \u003cp\u003e1 (0.5, 2)\u003c/p\u003e\n \u003cp\u003e1 (0, 2)\u003c/p\u003e\n \u003cp\u003e0 (0, 0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.818181818181818%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003cp\u003e0.487\u003c/p\u003e\n \u003cp\u003e0.235\u003c/p\u003e\n \u003cp\u003e0.926\u003c/p\u003e\n \u003cp\u003e0.465\u003c/p\u003e\n \u003cp\u003e0.846\u003c/p\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.818181818181817%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDASH score*\u003c/strong\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e1 week\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e6 weeks\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e3 months\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11.7 (7.5, 20.2)\u003c/p\u003e\n \u003cp\u003e3.3 (1.7, 10)\u003c/p\u003e\n \u003cp\u003e1.3 (0, 1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.181818181818183%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13.3 (11.7, 17.4)\u003c/p\u003e\n \u003cp\u003e8.3 (4.2, 10.4)\u003c/p\u003e\n \u003cp\u003e1.7 (1.3, 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13.3 (6.3, 19.4)\u003c/p\u003e\n \u003cp\u003e5.8 (1.7, 7.8)\u003c/p\u003e\n \u003cp\u003e1.7 (0, 2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.818181818181818%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.674\u003c/p\u003e\n \u003cp\u003e0.316\u003c/p\u003e\n \u003cp\u003e0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.818181818181817%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrip strength* (kg)\u003c/strong\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e1 week\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e6 weeks\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e3 months\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10 (10, 15)\u003c/p\u003e\n \u003cp\u003e18 (14, 20.5)\u003c/p\u003e\n \u003cp\u003e21 (19, 24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.181818181818183%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13 (9, 14)\u003c/p\u003e\n \u003cp\u003e16 (13, 20)\u003c/p\u003e\n \u003cp\u003e20 (18, 24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (6, 20)\u003c/p\u003e\n \u003cp\u003e18 (14, 22)\u003c/p\u003e\n \u003cp\u003e22.5 (19, 28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.818181818181818%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.649\u003c/p\u003e\n \u003cp\u003e0.384\u003c/p\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.818181818181817%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eROM of PIP joint* (degree)\u003c/strong\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e1 week\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e6 weeks\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e3 months\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e75 (57.5, 85)\u003c/p\u003e\n \u003cp\u003e80 (65, 92.5)\u003c/p\u003e\n \u003cp\u003e95 (70, 100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.181818181818183%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e78 (52, 88)\u003c/p\u003e\n \u003cp\u003e95 (65, 100)\u003c/p\u003e\n \u003cp\u003e95 (70, 100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e84.5 (70, 95)\u003c/p\u003e\n \u003cp\u003e97.5 (70, 105)\u003c/p\u003e\n \u003cp\u003e105 (75, 108)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.818181818181818%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.431\u003c/p\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003cp\u003e0.272\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.818181818181817%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eEcchymosis/Hematoma\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eNumbness\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eGI disturbance\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eWound dehiscence\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (8.7%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e2 (8.7%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.181818181818183%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (17.4%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e2 (8.7%)\u003c/p\u003e\n \u003cp\u003e1 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.09090909090909%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (26.1%)\u003c/p\u003e\n \u003cp\u003e1 (4.3%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.818181818181818%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.298\u003c/p\u003e\n \u003cp\u003e0.363\u003c/p\u003e\n \u003cp\u003e0.346\u003c/p\u003e\n \u003cp\u003e0.363\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Data were presented as median and interquartile range\u003c/p\u003e\n\u003cp\u003eNRS = numerical rating scale; DASH = Disability of arm, shoulder ,and hand; ROM = range of motion; PIP = proximal interphalangeal; GI = Gastrointestinal\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u003c/strong\u003ePost hoc analysis of NRS during finger movement at 6 hours postoperative period\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.69724770642202%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup comparisons\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.431192660550458%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean difference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.678899082568808%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.192660550458715%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% Confidence interval\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower bound\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper bound\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.69724770642202%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNSS + Ibuprofen VS Ketorolac alone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.431192660550458%\" valign=\"top\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.678899082568808%\" valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.596330275229358%\" valign=\"top\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.596330275229358%\" valign=\"top\"\u003e\n \u003cp\u003e3.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.69724770642202%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNSS + Ibuprofen VS Ketorolac + Ibuprofen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.431192660550458%\" valign=\"top\"\u003e\n \u003cp\u003e1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.678899082568808%\" valign=\"top\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.596330275229358%\" valign=\"top\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.596330275229358%\" valign=\"top\"\u003e\n \u003cp\u003e3.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.69724770642202%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKetorolac alone VS Ketorolac + Ibuprofen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.431192660550458%\" valign=\"top\"\u003e\n \u003cp\u003e-0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.678899082568808%\" valign=\"top\"\u003e\n \u003cp\u003e0.564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.596330275229358%\" valign=\"top\"\u003e\n \u003cp\u003e-2.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.596330275229358%\" valign=\"top\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eTukey\u0026rsquo;s Honest Significant Difference test\u003c/p\u003e\n\u003cp\u003eNRS = numerical rating scale; NSS = normal saline solution\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"trigger finger, trigger digit, local NSAIDs infiltration, open trigger finger surgery, postoperative pain","lastPublishedDoi":"10.21203/rs.3.rs-4550595/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4550595/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMultimodal analgesia is crucial for effective postoperative pain management in minor hand surgeries, enhancing patient satisfaction. The use of local wound infiltration with Ketorolac as an adjuvant pain management strategy is proposed for open trigger finger release surgery. This study aims to compare pain scores and functional outcomes between local wound infiltration with Ketorolac and oral non-steroidal anti-inflammatory drugs.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study is a double-blind, parallel design, randomized controlled trials. Sixty-nine patients underwent trigger finger surgery between December 2021 and October 2022 were randomized into one of three groups: oral Ibuprofen alone group, local Ketorolac alone group and local Ketorolac with oral Ibuprofen group. The assessment included postoperative numeric rating scale (NRS) pain score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, mobility of proximal interphalangeal (PIP) joint. and complications.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eNRS pain scores during movement of the operated fingers were significantly lower at 6 hours in local Ketorolac alone group and local Ketorolac with oral Ibuprofen group compared to oral Ibuprofen alone group. However, there were no significant differences between the groups in postoperative DASH scores, grip strength, mobility of PIP joints, and complications.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eLocal infiltration of Ketorolac is safe for use as an adjuvant postoperative pain management and provides superior pain control during finger movement within the first 6 hours following trigger finger surgery compared to oral NSAIDs.\u003c/p\u003e\u003ch2\u003eClinical trial registration:\u003c/h2\u003e \u003cp\u003eThaiclinicaltrials.org identifier: TCTR20210825002. Registered 25/08/2021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.thaiclinicaltrials.org/show/TCTR20210825002\u003c/span\u003e\u003cspan address=\"https://www.thaiclinicaltrials.org/show/TCTR20210825002\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eThis clinical trial was registered in the Thai Clinical Trials Registry (TCTR) on 25/08/2021: register number TCTR20210825002. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.thaiclinicaltrials.org/show/TCTR20210825002\u003c/span\u003e\u003cspan address=\"https://www.thaiclinicaltrials.org/show/TCTR20210825002\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e","manuscriptTitle":"Local Ketorolac Infiltration for Postoperative Pain in Open Trigger Finger Surgery: A Randomized Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-16 16:53:54","doi":"10.21203/rs.3.rs-4550595/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-24T06:19:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-24T00:35:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-23T19:49:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"162654656122666090034916765062733939515","date":"2024-07-22T11:11:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"338492716188504840219478370209932672593","date":"2024-07-21T21:55:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"167551758739897856580092158463775246681","date":"2024-07-21T11:31:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"7013684226849481688169302626841561602","date":"2024-07-20T19:37:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-20T15:10:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-03T01:56:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"43611319969683117407015288412567504130","date":"2024-06-25T22:48:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"203736446163542935343837093202581981578","date":"2024-06-24T03:23:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-23T22:36:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-20T09:32:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-14T06:37:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-14T06:37:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2024-06-08T12:31:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3f7b5d06-ce6a-46a9-86bc-3a018b863913","owner":[],"postedDate":"July 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-23T16:00:07+00:00","versionOfRecord":{"articleIdentity":"rs-4550595","link":"https://doi.org/10.1186/s12891-024-07856-6","journal":{"identity":"bmc-musculoskeletal-disorders","isVorOnly":false,"title":"BMC Musculoskeletal Disorders"},"publishedOn":"2024-09-17 15:57:07","publishedOnDateReadable":"September 17th, 2024"},"versionCreatedAt":"2024-07-16 16:53:54","video":"","vorDoi":"10.1186/s12891-024-07856-6","vorDoiUrl":"https://doi.org/10.1186/s12891-024-07856-6","workflowStages":[]},"version":"v1","identity":"rs-4550595","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4550595","identity":"rs-4550595","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}