Diclofenac Versus Ketorolac for Pain Control After Primary Total Joint Arthroplasty: A Comparative Analysis

Abstract

IntroductionAs total hip arthroplasty (THA) and total knee arthroplasty (TKA) transition to outpatient settings, appropriate pain management remains a challenge. Nonsteroidal anti-inflammatory drugs (NSAIDs) may subvert the need for postoperative opioids. This study evaluated: 1) total opioid consumption; 2) postoperative pain intensity; 3) discharge destination; 4) length of stay (LOS); and 5) THA and TKA patients' satisfaction in receiving adjunctive intravenous (IV) diclofenac or ketorolac. MethodsIn this retrospective cohort study, patients scheduled to undergo primary THA or TKA by a single surgeon between March 2017 and April 2018 were identified. Patients were stratified based on the receipt of IV diclofenac (THA: n = 25; TKA: n = 51) or IV ketorolac (THA: n = 28; TKA: n = 32) in addition to the standard pain management regimen. Student's t-testing and Chi-square were used to analyze continuous and categorical variables, respectively. ResultsTKA diclofenac patients had lower opioid consumption 12 hours postoperatively (p: 0.037). TKA patients in the diclofenac cohort were discharged to home less often (p: 0.025). Both diclofenac cohorts had greater patient satisfaction than the ketorolac cohorts (p: <0.05). There was no significant difference between groups in postoperative pain intensity at 24 or 48 hours or in the length of stay (p: >0.05 for all). ConclusionThis study demonstrated that both TKA and THA patients treated with IV diclofenac had no difference in postoperative pain intensity while THA patients had no difference in opioid consumption relative to those treated with IV ketorolac. Further comparison of IV NSAIDs with other IV pain medications may provide broader insight into the ideal management for postoperative pain for this widening patient population.

Super‐Strong Hydrogel Composites Reinforced with PBO Nanofibers for Cartilage Replacement

“…To evaluate the possibility of using PVA–PBO composites as drug delivery platforms, 6P1Z_AUT samples were loaded with the anti‐inflammatories diclofenac (DFN) and ketorolac (KTL), medicines that are commonly prescribed for the relief of inflammatory symptoms after an orthopedic surgery, whose local‐level vehiculation may bring benefits in terms of efficiency and reduction of side effects. [ 27,50,55 ]…”

“…To evaluate the possibility of using PVA-PBO composites as drug delivery platforms, 6P1Z_AUT samples were loaded with the anti-inflammatories diclofenac (DFN) and ketorolac (KTL), medicines that are commonly prescribed for the relief of inflammatory symptoms after an orthopedic surgery, whose local-level vehiculation may bring benefits in terms of efficiency and reduction of side effects. [27,50,55] After autoclaving the composites in the different loading solutions, the materials were left to load for 1 week. The stability of both drugs in solution after steam heat sterilization has been confirmed in a previous study.…”

“…After choosing the most suitable sterilization method, the friction behavior, wear, and biocompatibility of the sterilized sample were investigated. Finally, diclofenac and ketorolac, two clinically approved anti‐inflammatory drugs widely used after orthopedic surgeries, [ 55 ] were loaded individually into the elected material and in vitro drug release experiments were conducted.…”