Low-Dose Short-Term Scheduled Ketorolac Reduces Opioid Use and Pain in Orthopaedic Polytrauma Patients: A Randomized Clinical Trial

Jeffrey A. Foster, Matthew W. Kavolus, David C. Landy, Richard W. Pectol, Chandler R. Sneed, Daria L. Kinchelow, Jarod T. Griffin, Gregory S. Hawk, Andrew C. Bernard, Douglas Oyler, Arun Aneja

Research output: Contribution to journalArticlepeer-review

Abstract

Objective:To determine whether scheduled low-dose, short-term ketorolac is associated with reduced length of stay, opioid use, and pain in orthopaedic polytrauma patients.Design:Double-blinded, randomized controlled trial.Setting:One Level 1 trauma center.Patients:From August 2018 to October 2022, 70 orthopaedic polytrauma patients between 18 and 75 years of age with a New Injury Severity Score > 9 were randomized. Seventy participants were enrolled, with 35 randomized to the ketorolac group and 35 to the placebo group.Intervention:The intervention used was 15 mg of intravenous (IV) ketorolac every 6 hours for up to 5 inpatient days or 2 mL of IV saline in a similar fashion.Main Outcome Measurements:Length of stay (LOS), morphine milligram equivalents, visual analog scale, and complications.Results:Study groups were not significantly different regarding age, body mass index, and New Injury Severity Score (P > 0.05). The median LOS was 8 days (interquartile range, 4.5-11.5) in the ketorolac group compared with 7 days (interquartile range, 3-10) in the placebo group (P = 0.275). Over the 5-day treatment period, the ketorolac group experienced a 32% reduction in average morphine milligram equivalents (P = 0.013) and a 12-point reduction in baseline-adjusted mean visual analog scale (P = 0.037) compared with the placebo group. There were no apparent short-term adverse effects in either group.Conclusions:Scheduled low-dose, short-term IV ketorolac was associated with significantly reduced inpatient opioid use and pain in orthopaedic polytrauma patients, with no significant difference in LOS and no apparent short-term adverse effects. The results support the use of scheduled low-dose, short-term IV ketorolac for acute pain control among orthopaedic polytrauma patients. Further studies are needed to delineate lasting clinical effects and potential long-term effects, such as fracture healing.Level of Evidence:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish
Pages (from-to)633-639
Number of pages7
JournalJournal of Orthopaedic Trauma
Volume37
Issue number12
DOIs
StatePublished - Dec 1 2023

Bibliographical note

Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.

Keywords

  • acute pain management
  • decreased opioid use
  • IV ketorolac
  • morphine milligram equivalent
  • nonopioid pain management
  • orthopaedic polytrauma
  • visual analog scale

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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