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IV meloxicam leads to higher opioid requirements and longer hospital stays when compared with IV ketorolac after total joint arthroplasty.
A randomized controlled trial led by Michael G Rizzo et al. has revealed that intravenous (IV) meloxicam may not offer the same postoperative benefits as IV ketorolac for patients undergoing total joint arthroplasty. Despite meloxicam’s reputation for being gentler on the gastrointestinal tract, the study revealed higher opioid use and longer hospital stays among patients who received IV meloxicam compared with those treated with IV ketorolac.
This double-blind trial enrolled 223 patients undergoing arthroplasty. The study groups were as follows:
Researchers estimated pain degree, opioid consumption, and nausea at both two hours and 24 hours after surgery. A power analysis established a minimum sample size of 170 participants, which the study exceeded.
Key findings
The findings illustrated clear differences between the two NSAID regimens:
1. Higher Opioid Use With IV Meloxicam
Patients in the meloxicam group required more opioids within 24 hours of surgery, suggesting reduced effectiveness in early postoperative pain control.
2. Longer Hospital Stays
Meloxicam recipients illustrated longer lengths of stay and a lower rate of same-day discharge, an important metric as many hospitals aim to shift joint replacement procedures to outpatient settings.
3. No Difference in Nausea or Pain Scores
Despite differences in opioid needs and length of stay, pain ratings and postoperative nausea were similar between the two groups at all measured time points.
The findings indicate that IV meloxicam may not be an ideal substitute for IV ketorolac in postoperative pain care for joint replacement. Although meloxicam’s selective mechanism promises fewer gastrointestinal complications, it was linked to higher opioid needs and longer hospitalization. As healthcare systems continue to prioritize fast recovery and reduced opioid exposure, ketorolac appears to yield superior outcomes in this clinical setting.
Journal of Arthroplasty
Intravenous Meloxicam Versus Ketorolac for Pain Control Following Total Joint Arthroplasty: A Double-Blind Randomized Controlled Trial
Michael G Rizzo et al.
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