To the Editor:-We read with interest the excellent review article by Callesea and Kehlet [1]regarding pain after hernia repair. The authors conclude that intrawound nonsteroidal anti-inflammatory drugs (NSAIDs) have not been shown to have been beneficial in patients having herniorrhaphy.

We would like to cite our recently published article [2]in which we studied patients undergoing inguinal hernia repair during local anesthesia. The patients were randomized to receive ketorolac either intravenously or in the surgical wound. We were able to demonstrate an increased time to first analgesics, a decreased oral analgesic requirement, and lower 24-h movement-associated pain scores in the surgical site group.

We believe that our data, taken in concert with our studies in patients undergoing arthroscopy, [3,4]provide evidence that peripherally administered NSAIDs provide for patient benefit.

Neil Roy Connelly, M.D.

Scott S. Reuben, M.D.

Department of Anesthesiology; Baystate Medical Center; Tufts University School of Medicine; Springfield, Massachusetts 01199

Callesen T, Kehlet H: Postherniorrhaphy pain. Anesthesiology 1997; 87:1219-30
Connelly NR, Reuben SS, Albert M, Page D: Use of preincisional ketorolac in hernia patients. Reg Anesth 1997; 22(3):229-32
Reuben SS, Connelly NR: Postoperative analgesia for outpatients arthroscopic knee surgery with intraarticular bupivacaine and ketorolac. Anesth Analg 1995; 80:1154-7
Reuben SS, Connelly NR: Postarthroscopic meniscus repair analgesia with intraarticular ketorolac or morphine. Anesth Analg 1996; 82:1036-9