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

Abstract

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.