Low-Dose Short-Term Scheduled Ketorolac Reduces Opioid Use and Pain in Orthopaedic Polytrauma Patients: A Randomized Clinical Trial.

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 and 75 years of age with a New Injury Severity Score > 9 were randomized. Seventy participants were enrolled, with 35 randomized to the ketorolac group and 35 to the placebo group.

INTERVENTION

The intervention used was 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, visual analog scale, and complications.

RESULTS

Study groups were not significantly different regarding age, body mass index, and New Injury Severity Score ( P > 0.05). The median LOS was 8 days (interquartile range, 4.5-11.5) in the ketorolac group compared with 7 days (interquartile range, 3-10) in the placebo group ( P = 0.275). Over the 5-day treatment period, the ketorolac group experienced a 32% reduction in average morphine milligram equivalents ( P = 0.013) and a 12-point reduction in baseline-adjusted mean visual analog scale ( P = 0.037) compared with the placebo group. There were no apparent short-term adverse effects in either group.

CONCLUSIONS

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.