Compared to imrecoxib alone, ketorolac + imrecoxib provides better postoperative pain control without compromising safety or bone healing in tibial plateau fracture patients after ORIF.
In a retrospective cohort study, ketorolac tromethamine, when used in combination with imrecoxib, offered markedly better postoperative pain control in patients undergoing open reduction and internal fixation (ORIF) for tibial plateau fracture (TPF)—with no adverse effects on bone healing or organ function.
In total, 194 volunteers were recruited. Of these, 104 received ketorolac tromethamine + imrecoxib, while 90 received imrecoxib alone. Pain levels were evaluated via the visual analog scale (VAS) and Ramsay sedation scores at 1 and 6 hours post-anesthesia. Fracture healing was assessed via clinical healing time and biochemical markers such as alkaline phosphatase, bone gamma-carboxyglutamate protein, and collagen type I carboxy-terminal propeptide.
Safety outcomes encompassed monitoring adverse events and laboratory tests for liver, kidney, and blood function. Those in the ketorolac group reported substantially lower pain scores at both 1 hour (VAS, p = 0.017; Ramsay, p = 0.017) and 6 hours (VAS, p = 0.022; Ramsay, p = 0.034) after surgery when compared to the control group. Importantly, there were no statistically significant differences in fracture healing time or bone turnover markers (p > 0.05), and adverse events were similar between the groups.
Liver function tests (alanine aminotransferase, aspartate aminotransferase), kidney markers (creatinine, uric acid, β2-microglobulin), and routine blood indices such as hemoglobin and neutrophil-to-lymphocyte ratio also illustrated no vital differences, indicating ketorolac's safety in this setting. Thus, pairing ketorolac tromethamine with imrecoxib offered superior postoperative pain relief compared to imrecoxib alone. Notably, ketorolac showed no adverse effects on bone healing, positioning it as a bone-safe, effective adjunct to standard pain care protocols in orthopedic surgeries involving TPF.
Annali Italiani di Chirurgia
Prognostic Impact and Safety of Ketorolac Tromethamine in Tibial Plateau Fracture Patients Undergoing Open Reduction and Internal Fixation
Kai Lin et al.
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