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Postoperative Pain Management With Ketorolac, Acetaminophen, and Gabapentin in Femoral Shaft Fractures: A Prospective
Hans Hess Arcelay1, José I Acosta Julbe, Alexandra M Claudio-Marcano
1From 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).
Background:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
Level Of Evidence:
Prospective Cohort Study; Level 2.
