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Short-term usage of low-dose ketorolac safely reduced
the postsurgery opioid use and length of stay while maintaining an equivalent
postsurgery pain alleviation.
Ketorolac usage resulted in a considerable decline in the length of stay, total milligram morphine equivalence (MME) during hospitalization and the initial 48- hour after surgery (postsurgery opioid use) while maintaining equivalent postsurgery pain control in adults who underwent minimally invasive transforaminal posterior lumbar interbody fusion (TLIF), as per an interim analysis from a prospective randomized trial.
In this double-blinded, non-inferiority, placebo-controlled trial, researchers aimed to show non-inferiority regarding fusion rates in people receiving ketorolac after undergoing elective minimally invasive TLIF. Furthermore, the authors aimed to illustrate the opioid-sparing effect of ketorolac on analgesia in the immediate postsurgery period.
The study recruited people having degenerative spinal conditions who were eligible for undergoing a one to three-level TLIF. With the aid of bone morphogenetic protein, minimally invasive TLIF was carried out. Participants were randomly allocated to receive a forty-eight-hour scheduled therapy of either intravenous ketorolac (15 mg every six hours) or saline along with a standardized pain regimen. The major endpoints ascertained were six-month and one-year radiographic fusion as evaluated by Suk criteria.
The secondary endpoints ascertained were 48-hour and total postsurgery opioid use as estimated by MME, drug-associated complications, and length of stay. The self-reported and functional outcome measures incorporated Oswestry Disability Index, pain scores (visual analogue scale [VAS]), and short-form 12.
Univariate analyses were carried out. Evaluation of 246 people was done as per the protocol. Characteristics of participants were similar between the ketorolac and placebo groups. No profound differences were reported in the one-year fusion rates between the two therapies. The difference in the percentage of solid fusion between study groups didn't achieve inferiority.
A substantial decline in
total/48-hour mean opioid intake and length of stay was noted for the ketorolac
group while showing equivalent mean VAS scores in 48 hours after surgery. In
terms of rates of perioperative complications, no profound differences were
reported. Comparable/non-inferior fusion rates were noted between ketorolac and
placebo groups at six-month and one-year follow-up.
The Spine Journal
The Effect of Ketorolac on Posterior Minimally Invasive Transforaminal Lumbar Interbody Fusion: an interim analysis from a randomized, double-blinded, placebo-controlled trial
Chad F Claus et al.
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