In a recent research, published in the prestigious journal 'Spine,' intravenous Ketorolac emerged as a promising component of Enhanced Recovery After Surgery (ERAS) protocols due to its remarkable impact on opioid use reduction, improved pain control on the first postoperative day, and shorter hospital stays without increases in complications or pseudarthrosis.

This randomized, double-blinded, placebo-controlled trial was conducted by Sravisht Iyer and colleagues to assess the effects of intravenous ketorolac (IV-K) in comparison to intravenous placebo (IV-P) and intravenous acetaminophen (IV-A). Subjects aged 18 to 75 years who underwent 1-2 level lumbar fusion were included. Patients with chronic opioid use, smoking habits, and those with contraindications to any of the therapies used in this study were not considered.

The study utilized a block randomization scheme, with participants, hospital staff, and researchers kept unaware of the assignment. Following the lumbar spinal fusion, patients were randomly allocated to one of the following groups:

• IV-K group: Patients were given 15 mg (if age > 65) or 30 mg (if age <65) every 6 hours for 48 hours
• IV-A group: Patients were given 1000 mg every 6 hours
• IV-P group: Patients were given normal saline every 6 hours for 48 hours

The key data points included demographic and surgical specifics, opioid usage in morphine milliequivalents (MME), length of stay (LOS) at the hospital and opioid-related adverse events (ORAE). The key outcome of interest was in-hospital opioid use within the initial 72 hours. A total of 171 patients were included in the intent-to-treat (ITT) analysis, with an average age of 57.1 years. The IV-K group exhibited significantly lower opioid use at 72 hours (173±157 mg) when compared to IV-A (255±179 mg) and IV-P (299±179 mg) (P=0.000).

In terms of opioid use, IV-K proved superior to IV-A (P=0.025) and IV-P (P=0.000) on ITT analysis, although the difference with IV-A was not statistically significant. In comparison to IV-P, IV-K patients described significantly lower levels of worst (P=0.004), best (P=0.001), average (P=0.001), and current pain (P=0.002) on the first day after the surgery and experienced notable shorter LOS (P=0.009) on ITT analysis. In terms of ORAEs, drain output, clinical efficacy outcomes or fusion rates, no notable differences were found.