The Impact of Intraoperative Local Ketorolac on Opioid Use in the Management of Postoperative Pain in Thoracolumbar Spinal Fusions: A Retrospective Cohort Study.
ketorolac
lumbar fusion
postoperative pain control
Journal
International journal of spine surgery
ISSN: 2211-4599
Titre abrégé: Int J Spine Surg
Pays: Netherlands
ID NLM: 101579005
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
entrez:
24
7
2020
pubmed:
24
7
2020
medline:
24
7
2020
Statut:
epublish
Résumé
The United States is facing an opioid addiction epidemic with >63,600 deaths from drug overdoses in 2016 alone. Ketorolac is a nonsteroidal anti-inflammatory drug that has been shown to decrease postoperative pain in decompressive lumbar laminectomies. We sought to demonstrate that intraoperative intramuscular (IM) ketorolac is associated with decreased opioid use in the management of acute postoperative pain in thoracolumbar spinal fusions. A retrospective review of consecutive patients undergoing open and minimally invasive (MIS) thoracolumbar fusions between 2017 and 2018. Ketorolac (30 mg) was injected into the paraspinal muscles adjacent to the operative site before closure. Patients were placed on a standard pain control regimen. All demographic and surgical data were assessed with univariate analysis to assess for differences between groups. Univariate analysis was used to identify significant covariates for the linear regressions with postoperative morphine equivalents, length of stay (LOS), and visual analog scale (VAS) for pain as dependent variables. A Two hundred twenty-five consecutive patients were included with 58 patients receiving intraoperative IM ketorolac. The average age of the ketorolac groups was 63.4 years (23-87 years) with an even distribution between genders. There was no significant difference in demographic or surgical data between the 2 cohorts. Postoperative opioid use, when corrected for LOS, showed no significance between cohorts, ketorolac 16.4 mg (95% confidence interval [CI]: 12.3-20.5) and nonketorolac 6.7 mg (95% CI: 14.1-19.4, The use of a single dose of intraoperative IM ketorolac did not decrease the overall opioid requirements or shorten the LOS following open or MIS lumbar fusions. However, we did demonstrate benefit in early pain control, which makes this promising for further investigation. 3. This article promotes attention to the opioid crisis and the need for multimodal nonopioid based pain management in spine surgery.
Sections du résumé
BACKGROUND
BACKGROUND
The United States is facing an opioid addiction epidemic with >63,600 deaths from drug overdoses in 2016 alone. Ketorolac is a nonsteroidal anti-inflammatory drug that has been shown to decrease postoperative pain in decompressive lumbar laminectomies. We sought to demonstrate that intraoperative intramuscular (IM) ketorolac is associated with decreased opioid use in the management of acute postoperative pain in thoracolumbar spinal fusions.
METHODS
METHODS
A retrospective review of consecutive patients undergoing open and minimally invasive (MIS) thoracolumbar fusions between 2017 and 2018. Ketorolac (30 mg) was injected into the paraspinal muscles adjacent to the operative site before closure. Patients were placed on a standard pain control regimen. All demographic and surgical data were assessed with univariate analysis to assess for differences between groups. Univariate analysis was used to identify significant covariates for the linear regressions with postoperative morphine equivalents, length of stay (LOS), and visual analog scale (VAS) for pain as dependent variables. A
RESULTS
RESULTS
Two hundred twenty-five consecutive patients were included with 58 patients receiving intraoperative IM ketorolac. The average age of the ketorolac groups was 63.4 years (23-87 years) with an even distribution between genders. There was no significant difference in demographic or surgical data between the 2 cohorts. Postoperative opioid use, when corrected for LOS, showed no significance between cohorts, ketorolac 16.4 mg (95% confidence interval [CI]: 12.3-20.5) and nonketorolac 6.7 mg (95% CI: 14.1-19.4,
CONCLUSION
CONCLUSIONS
The use of a single dose of intraoperative IM ketorolac did not decrease the overall opioid requirements or shorten the LOS following open or MIS lumbar fusions. However, we did demonstrate benefit in early pain control, which makes this promising for further investigation.
LEVEL OF EVIDENCE
METHODS
3.
CLINICAL RELEVANCE
CONCLUSIONS
This article promotes attention to the opioid crisis and the need for multimodal nonopioid based pain management in spine surgery.
Identifiants
pubmed: 32699750
doi: 10.14444/7039
pmc: PMC7343257
doi:
Types de publication
Journal Article
Langues
eng
Pagination
294-299Informations de copyright
©International Society for the Advancement of Spine Surgery 2020.
Déclaration de conflit d'intérêts
Disclosures and COI: The authors have no financial disclosures to declare. There was no funding from any sources for this study. IRB number: 1196245-1.
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