Heidari Bijan, Salimi Rasoul, Saremi Hossein, Arab Ghahestani Mostafa
Department of Orthopedics, School of Medicine, Besat Hospital, Hamadan, Iran.
Department of Emergency Medicine, School of Medicine, Besat Hospital, Hamadan, Iran.
Arch Bone Jt Surg. 2023;11(6):414-420. doi: 10.22038/ABJS.2023.64778.3109.
Intertrochanteric fracture is a common fracture that mainly occurs in the elderly. Diverse pain management strategies have been applied; however, considering the age of the patients, analgesia-related complications should be concisely considered. The current study aims to evaluate the efficacy and adverse effects of Ketorolac plus placebo versus Ketorolac plus magnesium sulfate for pain management in intertrochanteric fractures.
The current randomized clinical trial has been conducted on 60 patients with intertrochanteric fractures assigned into two groups of treatment with Ketorolac (30 mg) plus placebo (n=30) versus Ketorolac (30 mg) plus magnesium sulfate (15 mg/kg) (n=30). Pain scores using the visual analog scale (VAS), hemodynamic parameters, and complications (nausea and vomiting) were assessed at baseline and within 20, 40, and 60 minutes after the interventions. Additional morphine sulfate requirements were compared between the groups.
Demographic characteristics in both groups were similar (P>0.05). All the assessments showed statistically significantly less pain severity in the magnesium sulfate/Ketorolac group (P<0.05), except for the baseline assessments (P=0.873). The two groups did not differ regarding hemodynamic parameters, nausea, and vomiting complaints (P>0.05). Although the frequency of additional morphine sulfate requirement was not different between the groups (P=0.06), the administered dose of morphine sulfate was significantly higher in those treated with ketorolac/placebo (P=0.002).
Based on the findings of this study, Ketorolac alone or in combination with magnesium sulfate led to significant pain reduction in patients with intertrochanteric fractures admitted to the emergency ward; however, the combination therapy had superior outcomes. Further studies are strongly recommended.
粗隆间骨折是一种主要发生于老年人的常见骨折。已应用了多种疼痛管理策略；然而，考虑到患者的年龄，应简要考虑与镇痛相关的并发症。本研究旨在评估酮咯酸加安慰剂与酮咯酸加硫酸镁在粗隆间骨折疼痛管理中的疗效和不良反应。
本随机临床试验对60例粗隆间骨折患者进行，分为两组，一组接受酮咯酸（30 mg）加安慰剂治疗（n = 30），另一组接受酮咯酸（30 mg）加硫酸镁（15 mg/kg）治疗（n = 30）。在基线以及干预后20、40和60分钟时，使用视觉模拟量表（VAS）评估疼痛评分、血流动力学参数以及并发症（恶心和呕吐）。比较两组间额外的硫酸吗啡需求量。
两组的人口统计学特征相似（P>0.05）。除基线评估外（P = 0.873），所有评估均显示硫酸镁/酮咯酸组的疼痛严重程度在统计学上显著更低（P<0.05）。两组在血流动力学参数、恶心和呕吐主诉方面无差异（P>0.05）。尽管两组间额外硫酸吗啡需求量的频率无差异（P = 0.06），但酮咯酸/安慰剂治疗组的硫酸吗啡给药剂量显著更高（P = 0.002）。
基于本研究结果，单独使用酮咯酸或与硫酸镁联合使用均可使急诊病房收治的粗隆间骨折患者的疼痛显著减轻；然而，联合治疗效果更佳。强烈建议进一步开展研究。
