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Ketorolac, acetaminophen, and gabapentin offer postoperative pain relief comparable to opioid-based therapy while reducing opioid consumption after intramedullary nailing of isolated femoral shaft fractures.
A prospective cohort study highlights the potential of multimodal nonopioid analgesia to reduce opioid exposure following femoral shaft fracture surgery without compromising pain control. The study enrolled 71 patients with isolated femoral shaft fractures tackled with intramedullary nailing. Overall, 29 patients received a multimodal regimen consisting of intravenous ketorolac, oral acetaminophen, and oral gabapentin, while 42 patients received standard opioid-based postoperative analgesia.
Postoperative pain was assessed using visual analog scale (VAS) scores, and opioid consumption was measured in morphine milligram equivalents (MME) at 12-hour intervals for up to 48 hours after surgery. Despite a younger average age in the multimodal group (31 vs. 40 years; P=0.002), baseline characteristics, including sex, body mass index, smoking status, and diabetes prevalence, were similar between groups.
The multimodal regimen achieved pain control comparable to standard opioid therapy, with no significant differences in VAS scores at 12, 24, 36, or 48 hours postoperatively. Importantly, patients receiving ketorolac, acetaminophen, and gabapentin required markedly fewer opioids throughout the 48-hour postoperative period, with opioid consumption markedly reduced at every time point (P<0.001).
The findings suggest that combining ketorolac, acetaminophen, and gabapentin offers an effective opioid-sparing approach for managing postoperative pain after femoral shaft fracture fixation. The authors note that larger studies involving more diverse orthopaedic trauma populations are needed to validate these findings and evaluate long-term outcomes.
JAAOS Global Research & Reviews
Postoperative Pain Management With Ketorolac, Acetaminophen, and Gabapentin in Femoral Shaft Fractures: A Prospective Cohort Study
Hess Arcelay et al.
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