Hess Arcelay Hans, Acosta Julbe José I, Claudio-Marcano Alexandra M, Cedeño Rodriguez Francis X, Martinez Edgardo, Tresgallo Ruben, Ramirez Lluch Norman, Lojo-Sojo Luis
From the Department of Orthopedic Surgery, University of Puerto, Río Piedras, Puerto Rico (Dr. Hess Arcelay, Dr. Acosta Julbe, Dr. Claudio-Marcano, Dr. Martinez, and Dr. Lojo-Sojo); the School of Medicine, University of Puerto Rico, San Juan, Puerto Rico (Mr. Cedeño Rodriguez); the Division of Arthroplasty, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA (Dr. Tresgallo); the Department of Orthopaedic Surgery, Mayagüez Medical Center, Mayagüez, Puerto Rico (Dr. Ramirez Lluch); and the School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico (Dr. Ramirez Lluch).
J Am Acad Orthop Surg Glob Res Rev. 2025 May 8;9(5). doi: 10.5435/JAAOSGlobal-D-25-00027. eCollection 2025 May 1.
Postoperative pain management in orthopaedic trauma surgery is critical. Amid the opioid crisis, nonopioid analgesia offers a promising alternative. We aim to evaluate the feasibility of a multimodal regimen, including intravenous ketorolac, oral acetaminophen, and oral gabapentin, in managing postoperative pain after femur shaft fractures treated with intramedullary nailing.
We conducted a prospective cohort study to evaluate the postoperative pain of patients with isolated femur shaft fractures treated with intramedullary nailing. The experimental group consisted of 29 patients, while the control group consisted of 42 patients who received standard opioid-based pain management. The outcomes measured were the Visual Analog Scale (VAS) scores and the morphine milligram equivalents every 12 hours until 48 hours postoperatively.
Patient demographics were comparable between the experimental and control groups, with a significant age difference (31 vs. 40; P = 0.002) but not in sex, body mass index, smoking status, or diabetes prevalence. We observed no significant differences in VAS scores at 12, 24, 36, and 48 hours after surgery. In addition, there was a marked reduction in opioid usage in the experimental group, with P-values < 0.001 at each time point.
The study concludes that the coadministration of ketorolac, acetaminophen, and gabapentin is an effective opioid-sparing alternative for postoperative pain in isolated femur shaft fractures. Future research could benefit from a more diverse patient population in orthopaedic trauma to further validate our results and explore long-term outcomes.
Prospective Cohort Study; Level 2.
骨科创伤手术中的术后疼痛管理至关重要。在阿片类药物危机期间，非阿片类镇痛提供了一种有前景的替代方案。我们旨在评估一种多模式方案，包括静脉注射酮咯酸、口服对乙酰氨基酚和口服加巴喷丁，在髓内钉治疗股骨干骨折后管理术后疼痛的可行性。
我们进行了一项前瞻性队列研究，以评估接受髓内钉治疗的孤立股骨干骨折患者的术后疼痛。实验组由29名患者组成，而对照组由42名接受基于阿片类药物的标准疼痛管理的患者组成。测量的结果是视觉模拟量表（VAS）评分和术后48小时内每12小时的吗啡毫克当量。
实验组和对照组的患者人口统计学特征具有可比性，年龄存在显著差异（31岁对40岁；P = 0.002），但在性别、体重指数、吸烟状况或糖尿病患病率方面无差异。我们观察到术后12、24、36和48小时的VAS评分无显著差异。此外，实验组的阿片类药物使用量明显减少，每个时间点的P值<0.001。
该研究得出结论，酮咯酸、对乙酰氨基酚和加巴喷丁联合使用是孤立股骨干骨折术后疼痛的一种有效的阿片类药物节省替代方案。未来的研究可以受益于骨科创伤中更多样化的患者群体，以进一步验证我们的结果并探索长期结果。
前瞻性队列研究；2级。
