The Use of Ketorolac in Lumbar Spine Surgery: A Cost???Benefit Analysis

Turner, Donn M.; Warson, James S.; Wirt, Timothy C.; Scalley, Robert D.; Cochran, Robert; Miller, Kay J.

doi:10.1097/00002517-199506000-00005

Cited by 47 publications

(32 citation statements)

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“…Le Roux et at reported that the use of NSAIDS as the sole medication for pain control after spine surgery was not sufficient to provide adequate analgesia, 31 but when combined with opioids, the combination results in much better results than with either one alone. [31][32][33][34] Reuben SS et al reported NSAIDS has opioid sparing effect for postoperative pain management after spine surgery. 35 Ketorolac, given IM or IV, is the most investigated drug among the NSAIDS.…”

Section: Discussionmentioning

confidence: 99%

“…[31][32][33] Turner DM et al reported ketorolac has provided good analgesia after lumbar spine surgery and less opioid requirement as well as it was cost effective. 34 Because its onset of action is not immediate (about 30-60 minutes after IM injection), its use in severe acute pain in the postoperative period is best as an adjuvant to opioids, rather than as a sole agent. There is also a concern regarding the deleterious effects of NSAIDS on bone healing, because of the importance of PGE2 in the early stages of bone healing.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative analgesia after lumbar disc surgery: A comparison between ketorolac and opioid

Kamal

Maruf²,

Yeasmeen

et al. 2014

j Bangladesh Soc Anaesthesiologists

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Postoperative analgesia after lumbar disc surgery: A comparison between ketorolac and opioid

Kamal

Maruf²,

Yeasmeen

et al. 2014

j Bangladesh Soc Anaesthesiologists

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“…Although NSAIDs have proven to be beneficial in the multimodal management of pain following spinal fusion surgery, [8][9][10][11][12][13] many physicians refrain from the use of these drugs because of a possible deleterious effect on osteogenesis and spinal fusion. [17][18][19][20] Spinal fusion is a complex process that is influenced by multiple physiologic and mechanical factors.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12][13] A cost-benefit analysis revealed a net savings to the institution of over $211,000 per year or over $350 per patient in those patients receiving NSAIDs for lumbar spine surgery. 12 In addition to these short-term analgesic benefits, a reduction in acute pain provided by perioperative NSAID administration may also reduce long-term morbidity following spinal fusion surgery.…”

Section: Onsteroidalmentioning

confidence: 99%

High dose nonsteroidal anti-inflammatory drugs compromise spinal fusion

Reuben

Ablett

Kaye

2005

Can J Anesth/J Can Anesth

122

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P Pu ur rp po os se e: : Although nonsteroidal anti-inflammatory drugs (NSAIDs) provide benefit to patients following spinal fusion surgery, their routine administration has remained controversial due to concerns about possible deleterious effects on bone healing. The goal of this retrospective study was to assess the incidence of non-union following the perioperative administration of ketorolac, celecoxib, or rofecoxib. R Re es su ul lt ts s: : There were no significant differences in the incidence of non-union among the groups that received no NSAIDs (11/130; 8.5%), celecoxib 5/60; 8.3%), or rofecoxib (9/124; 7.3%). In contrast, 23/120 of patients (19.2%) that received ketorolac had a higher incidence (P < 0.001) of non-union compared to non-NSAID users. However, only 3/50 patients (6%) receiving low-dose ketorolac (# 110 mg·day -1 ) resulted in non-union which was not significantly different from non-NSAID users. Patients administered higher doses of ketorolac (120-240 mg·day -1 ) resulted in a higher incidence (P < 0.0001) of non-union (20/70; 29%) compared to non-NSAID users. For those patients developing non-union, there was a higher incidence comparing smokers vs non-smokers (P < 0.0001) and one level fusion vs two level fusions (P < 0.001).C Co on nc cl lu us si io on ns s: : This study revealed that the short-term perioperative administration of celecoxib, rofecoxib, or low-dose ketorolac (# 110 mg·day -1 ) had no significant deleterious effect on nonunion. In contrast, higher doses of ketorolac (120-240 mg·day -1 ), history of smoking, and two level vertebral fusions resulted in a significant increase in the incidence of non-union following spinal fusion surgery. (120-240 mg·jour -1 ), comparées aux non-AINS, ont provoqué une plus haute incidence (P < 0,0001) d'absence de fusion (20/70 ; 29 %) Objectif : Les anti-inflammatoires non stéroïdiens (AINS . L'incidence d'absence de fusion était plus élevée si on compare les fumeurs vs les non-fumeurs (P < 0,0001) et la fusion à un niveau vs à deux niveaux (P < 0,001). Conclusion

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“…Opioid analgesics are the most widely used drugs but carry unpleasant side eff ects 19 . Nonsteroidal anti-infl ammatory drugs (NSAIDs) have proven efficacy in ameliorating postoperative pain, especially following spinal surgery [20][21][22] . Side eff ects such as gastric irritation, inhibition of platelet aggregation and bleeding have restricted their wide use 23 .…”

Section: Introductionmentioning

confidence: 99%

Analgesic Effect – Comparison of Paracetamol Administered Intermittently and Through Patient-Controlled Analgesia Pump after Lumbar Discectomy: a Prospective Clinical Study

Kurtović

Rotim

Batinica³

et al. 2017

acc

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SUMMARY -Lumbar discectomy is the most common surgical treatment for intervertebral disc extrusion. Postoperative pain is a common clinical problem that greatly aff ects the length of hospitalization, functional status and patient quality of life. Th e aim of this study was to compare the postoperative analgesic effi cacy of paracetamol administered intermittently and through patient-controlled analgesia (PCA) pump following single level lumbar discectomy. Patients who underwent elective lumbar discectomy of intervertebral disc extrusion at the L4-L5 level diagnosed by magnetic resonance of the lumbosacral spine were included in the study. Pain was assessed at regular intervals for 48 hours through a shortened version of McGill pain questionnaire translated in the Croatian language. When pain was monitored as a summarized variable for each measurement, PCA group signifi cantly stood up after 24 hours with better perception of pain compared to the intermittent group (c 2 -test, p<0.05). Adequate pain relief is an important aspect of postoperative care in spinal surgery patients. Postoperative use of paracetamol through PCA pump achieved better pain control and pain management versus postoperative use of intermittent paracetamol analgesia after lumbar discectomy.

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The Use of Ketorolac in Lumbar Spine Surgery: A Cost???Benefit Analysis

Cited by 47 publications

References 0 publications

Postoperative analgesia after lumbar disc surgery: A comparison between ketorolac and opioid

Postoperative analgesia after lumbar disc surgery: A comparison between ketorolac and opioid

High dose nonsteroidal anti-inflammatory drugs compromise spinal fusion

Analgesic Effect – Comparison of Paracetamol Administered Intermittently and Through Patient-Controlled Analgesia Pump after Lumbar Discectomy: a Prospective Clinical Study

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