TY - JOUR
T1 - Low-Dose Short-Term Scheduled Ketorolac Reduces Opioid Use and Pain in Orthopaedic Polytrauma Patients
T2 - A Randomized Clinical Trial
AU - Foster, Jeffrey A.
AU - Kavolus, Matthew W.
AU - Landy, David C.
AU - Pectol, Richard W.
AU - Sneed, Chandler R.
AU - Kinchelow, Daria L.
AU - Griffin, Jarod T.
AU - Hawk, Gregory S.
AU - Bernard, Andrew C.
AU - Oyler, Douglas
AU - Aneja, Arun
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/12/1
Y1 - 2023/12/1
N2 - 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.
AB - 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.
KW - acute pain management
KW - decreased opioid use
KW - IV ketorolac
KW - morphine milligram equivalent
KW - nonopioid pain management
KW - orthopaedic polytrauma
KW - visual analog scale
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UR - http://www.scopus.com/inward/citedby.url?scp=85178098248&partnerID=8YFLogxK
U2 - 10.1097/BOT.0000000000002703
DO - 10.1097/BOT.0000000000002703
M3 - Article
C2 - 37752630
AN - SCOPUS:85178098248
SN - 0890-5339
VL - 37
SP - 633
EP - 639
JO - Journal of Orthopaedic Trauma
JF - Journal of Orthopaedic Trauma
IS - 12
ER -