A new systematic review suggests that ketorolac might work well for post-surgical pain control, such as after spine surgery. It may significantly cut the need for opioids in these patients. But most studies on ketorolac are small. Larger studies are still needed.
Non-steroidal anti-inflammatory drugs (NSAIDs) have been around for a long time. They are the most widely used painkillers in the world. They ease pain, and they also bring down swelling and fever. Aspirin and Ibuprofen are common NSAIDs. In many nations you can buy them without a prescription.
There are tens of NSAIDs. They differ in strength, in how long they last, and in safety. What makes these drugs great is that most of them are very safe. That is why many of them are sold without a prescription.
These drugs work well for mild to moderate pain. Some are better at calming inflammation (swelling and irritation). Others are better at blocking pain. So the NSAIDs are not all the same. Some even work for severe pain or chronic pain. That is why we need to know how they differ. These drugs can also replace opioids at times, or significantly cut the dose needed. Doctors know this well.
These drugs have a proven safety record. Sadly, there is not enough research on their use in different conditions. There are many small studies. But hard data from large clinical trials is often missing. That is why doctors hold back from using them for some kinds of pain.
Ketorolac is one such NSAID. It is known to give good pain relief, mainly for short-term pain like pain after surgery. It may significantly cut the need for opioids.
A systematic review was just published on how well it controls pain after spine surgery. Studies suggest ketorolac may significantly help people who have lumbar spine surgery (surgery on the lower back). This holds whether it is used alone or with other painkillers. Ketorolac may also be used along with opioids or other painkillers.
In the new study, researchers found 13 studies on the topic. In them, ketorolac was used alone or with drugs like bupivacaine, morphine, epinephrine, acetaminophen, and pregabalin.
Researchers found that ketorolac was significantly better than placebo for pain control after spinal surgery. This held from six to 12 hours and from 12 to 24 hours after surgery. It worked best in the first six hours. After six hours, its effect on pain started to fade.
Ketorolac could also significantly cut the amount of morphine patients needed after surgery. That means it could cut the need for opioids.
It also could shorten the hospital stay a bit. That is because it eases pain, and probably also because it calms inflammation.
But nausea, vomiting, and constipation were just as common in the ketorolac group as in the control group. Researchers also warned that ketorolac may cause severe side effects in some people. These include acute (sudden) kidney injury, stomach bleeding, and anaphylaxis (a severe allergic reaction). Keep this in mind when using it for pain.
The study authors noted that ketorolac seems to work well for pain after surgery. But they also noted that most studies on the topic were small. Larger clinical trials are needed to define its role in pain care for these patients.
Source:
Guan, J., Feng, N., Yang, K., Abudouaini, H., & Liu, P. (2024). The efficacy and safety of ketorolac for postoperative pain management in lumbar spine surgery: A meta-analysis of randomized controlled trials. Systematic Reviews, 13(1), 275. https://doi.org/10.1186/s13643-024-02685-z
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