PMID- 37752630
OWN - NLM
STAT- Publisher
LR  - 20230927
IS  - 1531-2291 (Electronic)
IS  - 0890-5339 (Linking)
DP  - 2023 Sep 25
TI  - Low-Dose Short-Term Scheduled Ketorolac Reduces Opioid Use and Pain in 
      Orthopaedic Polytrauma Patients: A Randomized Clinical Trial.
LID - 10.1097/BOT.0000000000002703 [doi]
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 18-75 years-old with a New Injury 
      Severity Score (NISS) > 9 were randomized. 70 participants were enrolled, with 35 
      randomized to the ketorolac group and 35 to the placebo group. INTERVENTION: 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 (MME), Visual Analogue Scale (VAS), and 
      Complications. RESULTS: Study groups were not significantly different with 
      respect to age, BMI, and NISS (p>0.05). Median LOS was 8 days (interquartile 
      range [IQR], 4.5 to 11.5) in the ketorolac group compared to 7 days (IQR, 3 to 
      10) in the placebo group (p = 0.275). Over the 5-day treatment period, the 
      ketorolac group experienced a 32% reduction in average MME (p = 0.013) and a 
      12-point reduction in baseline-adjusted mean VAS (p = 0.037) compared to the 
      placebo group. There were no apparent short-term adverse effects in either group. 
      CONCLUSION: 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.
CI  - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Foster, Jeffrey A
AU  - Foster JA
AUID- ORCID: 0000-0003-3875-5401
AD  - Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky.
FAU - Kavolus, Matthew W
AU  - Kavolus MW
AUID- ORCID: 0000-0002-3712-1792
AD  - Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky.
FAU - Landy, David C
AU  - Landy DC
AUID- ORCID: 0000-0002-4024-7679
AD  - Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky.
FAU - Pectol, Richard W
AU  - Pectol RW
AUID- ORCID: 0000-0002-6821-3382
AD  - Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky.
FAU - Sneed, Chandler R
AU  - Sneed CR
AUID- ORCID: 0000-0001-8640-7124
AD  - Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky.
FAU - Kinchelow, Daria L
AU  - Kinchelow DL
AUID- ORCID: 0000-0002-0185-6068
AD  - Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky.
FAU - Griffin, Jarod T
AU  - Griffin JT
AUID- ORCID: 0000-0002-5605-4767
AD  - Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky.
FAU - Hawk, Gregory S
AU  - Hawk GS
AUID- ORCID: 0000-0001-8935-9965
AD  - Department of Statistics, University of Kentucky.
FAU - Aneja, Arun
AU  - Aneja A
AUID- ORCID: 0000-0002-1507-6863
AD  - Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky.
LA  - eng
PT  - Journal Article
DEP - 20230925
PL  - United States
TA  - J Orthop Trauma
JT  - Journal of orthopaedic trauma
JID - 8807705
SB  - IM
COIS- Conflicts of Interest and Source of Funding: This project was aided by a grant 
      from the Orthopaedic Trauma Association. The authors declare no conflicts of 
      interest relevant to the submitted work.
EDAT- 2023/09/27 06:42
MHDA- 2023/09/27 06:42
CRDT- 2023/09/27 00:13
PHST- 2023/09/27 06:42 [medline]
PHST- 2023/09/27 06:42 [pubmed]
PHST- 2023/09/27 00:13 [entrez]
AID - 00005131-990000000-00264 [pii]
AID - 10.1097/BOT.0000000000002703 [doi]
PST - aheadofprint
SO  - J Orthop Trauma. 2023 Sep 25. doi: 10.1097/BOT.0000000000002703.