Ketorolac and Acetaminophen for postoperative pain management: A randomized study

NSAID-based protocols effectively reduce opioid use without compromising pain relief or healing in people with tibial shaft fractures with intramedullary nailing, which can help mitigate risks associated with opioid use in these patients.

NSAIDs are effective for fracture pain and have minimal impact on healing. With the opioid crisis, alternative pain management is important. This randomized controlled trial examined if Acetaminophen oral and intravenous administration of Ketorolac can replace opioids for pain control in closed tibial shaft fractures treated with intramedullary nailing.

To assess the postoperative pain management and opioid use among patients who underwent intramedullary nailing for closed tibial shaft fractures, the study participants were randomly allocated to either an NSAID-based pain management group (52 patients) or an opioid-based pain management group (44 patients).

The Visual Analog Scale (VAS) scores and calculated Morphine Milligram Equivalents (MMEs) at 12-hour intervals were monitored over the initial 48 hours’ post-surgery. The rates of nonunion and delayed healing in both treatment groups were also documented.

The NSAID group exhibited statistically significant reductions in MMEs compared to the opioid group at all measured intervals (12, 24, 36, and 48 hours) with corresponding p-values of 0.001, 0.001, 0.040, and 0.024, respectively.

Visual analogue scale scores indicated no significant disparities between the groups at 12, 36 and 48 hours, except for a noteworthy decrease at 24 hours in the NSAID group than the opioid group (p-value 0.041). There were no significant variations in union rates between the groups.

Using an NSAID-based pain protocol reduced opioid use without affecting pain scores or bone healing rates, justifying their role in managing perioperative pain for tibial shaft fractures.