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Postoperative ketorolac reduces opioid consumption and early pain scores without increasing the risk of delayed fracture healing after ankle fracture surgery.
A randomized study suggests that adding ketorolac, a nonnarcotic nonsteroidal anti-inflammatory drug (NSAID), to postoperative care can substantially reduce opioid consumption after ankle fracture surgery, offering a promising strategy in the fight against the opioid epidemic.
The study enrolled 128 patients undergoing open reduction and internal fixation (ORIF) for acute ankle fractures. Volunteers were randomly allocated into two groups: one receiving ketorolac with opioids (56 patients) and the other receiving opioids alone (50 patients). Participants (42% men, 58% women; mean age 48 years) reported daily outcomes for 7 days, including pain scores (VAS), opioid use, sleep interference, and side effects. Clinical and radiographic healing were assessed at 12 weeks by blinded orthopaedic surgeons. Overall, 83% (106 patients) completed the study.
Patients treated with ketorolac consumed fewer opioids, averaging 14 pills compared to 19.3 pills in the control group. They also experienced lower visual analog scale (VAS) pain scores during the first two postoperative days, although improvements in overall pain and sleep quality were not consistently observed. Importantly, there was no vital difference in fracture healing, with similar rates of clinical recovery and radiographic union between groups.
The addition of ketorolac to postoperative regimens after ankle fracture surgery can decrease opioid requirements and offer modest early pain relief without compromising bone healing. Although further large-scale studies are needed to substantiate long-term safety, these findings support the role of ketorolac in multimodal, opioid-sparing pain management strategies.
Clinical Orthopaedics and Related Research
How Does Perioperative Ketorolac Affect Opioid Consumption and Pain Management After Ankle Fracture Surgery?
Elizabeth L McDonald et al.
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