Day Case Lumbar Fusion Surgery
This article is a summary of a randomized, double-blinded, placebo-controlled trial that investigated the effect of intravenous ketorolac (IV-K) on opioid use in hospital compared to IV placebo (IV-P) and IV acetaminophen (IV-A) following lumbar spinal fusion surgery. The study aimed to control postoperative pain while minimizing opioid use. Patients between the ages of 18 and 75 undergoing lumbar fusion were included in the study. The results showed that the IV-K group had significantly lower opioid use at 72 hours compared to the IV-A and IV-P groups. IV-K was also associated with improved pain control on postoperative day 1 (POD1) and a shorter length of stay (LOS) in the hospital. There were no differences in complications or fusion rates between the groups. The study suggests that IV-K may be an important component of enhanced recovery after surgery (ERAS) protocols due to its ability to reduce opioid use and improve pain control without increasing complications
Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most established spinal facility in UK
Published article
S: By reducing opioid use, improving pain control on POD1, and decreasing LOS without increases in complications or pseudarthrosis, IV-K may be an important component of ERAS protocols.
Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
Spine (Phila Pa 1976). 2023 Sep 22. doi: 10.1097/BRS.0000000000004831. Online ahead of print.ABSTRACTSTUDY DESIGN: Randomized, double-blinded, placebo-controlled trial.OBJECTIVE: Examine the effect of intravenous ketorolac (IV-K) on hospital opioid use compared to IV placebo (IV-P) and IV acetaminophen (IV-A).SUMMARY OF BACKGROUND DATA: Controlling postoperative pain while minimizing opioid use following lumbar spinal fusion is an important,
Spine (Phila Pa 1976). 2023 Sep 22. doi: 10.1097/BRS.0000000000004831. Online ahead of print.
ABSTRACT
STUDY DESIGN: Randomized, double-blinded, placebo-controlled trial.
OBJECTIVE: Examine the effect of intravenous ketorolac (IV-K) on hospital opioid use compared to IV placebo (IV-P) and IV acetaminophen (IV-A).
SUMMARY OF BACKGROUND DATA: Controlling postoperative pain while minimizing opioid use following lumbar spinal fusion is an important area of study.
METHODS: Patients aged 18-75 years undergoing 1-2 level lumbar fusion between April 2016 – December 2019 were included. Patients with chronic opioid use, smokers, and those on systemic glucocorticoids or contraindications to study medications were excluded. A block randomization scheme was used and study personnel, hospital staff, and subjects were blinded to assignment. Patients were randomized postoperatively. The IV-K group received 15mg (age > 65) or 30 mg (age <65) q6h for 48h, IV-A received 1000 mg q6h, and IV-P received normal saline q6h for 48h. Demographic and surgical details, opioid use in morphine milliequivalents (MME), opioid related adverse events (ORAE) and length of stay (LOS) were recorded. The primary outcome was in-hospital opioid use up to 72h.
RESULTS: 171 patients were included (58 IV-K, 55 IV-A, 58 IV-P) in the intent-to-treat (ITT) analysis, with mean age 57.1 years. The IV-K group had lower opioid use at 72h (173±157 mg) versus IV-A (255±179 mg) and IV-P (299±179 mg) (P=0.000). In terms of opiate use, IV-K was superior to IV-A (P=0.025) and IV-P (P=0.000) on ITT analysis, although on per-protocol (PP) analysis the difference with IV-A did not reach significance (P=0.063). When compared to IV-P, IV-K patients reported significantly lower worst (P=0.004), best (P=0.001), average (P=0.001), and current pain (P=0.002) on POD1, and significantly shorter LOS (P=0.009) on ITT analysis. There were no differences in ORAEs, drain output, clinical outcomes, transfusion rates, or fusion rates.
S: By reducing opioid use, improving pain control on POD1, and decreasing LOS without increases in complications or pseudarthrosis, IV-K may be an important component of ERAS protocols.
PMID:37737686 | DOI:10.1097/BRS.0000000000004831
The London Spine Unit : most established spinal facility in UK
Read the original publication:
Intravenous Ketorolac Substantially Reduces Opioid Use and Length of Stay After Lumbar Fusion: A Randomized Controlled Trial
