A new systemic review suggests that ketorolac might be quite effective for post-surgical pain control, like those in spine surgery patients. It may significantly reduce the need for opioids in these patients. However, researchers also noticed that most studies using ketorolac have small sample sizes and thus need more extensive studies.
Non-steroidal anti-inflammatory drugs (NSAIDs) have been around for long. They are the most extensively used painkillers globally. They help reduce not only pain but also inflammation and fever. Aspirin and Ibuprofen are examples of some of the commonly used NSAIDs that are even available without prescription in many nations.
There are tens of NSAIDs, and they differ in potency, duration of action, and safety profile. What makes these drugs great is that most of them have an excellent safety profile. That is why many drugs from this class are even sold without a prescription.
These drugs are quite good for mild to moderate pain. Some are better at reducing inflammation, while others are better at suppressing pain. So, there is a significant difference between various NSAIDs. Some of the NSAIDs are even good for severe pain or chronic pain. Thus, there is a need to fully understand the difference between various NSAIDs. Moreover, these drugs can sometimes replace opioids, or they reduce their requirement significantly – something well-known to doctors.
However, despite their proven safety record, it is unfortunate that there is insufficient research into their use in different clinical conditions. Though there are many small clinical studies, robust data/findings from large clinical trials are often missing. This is the reason why doctors are hesitant to use them for certain pain conditions.
Ketorolac is one such NSAID. It is known to be quite good for pain relief, especially for acute pains like postoperative pain. It may significantly reduce the requirement for opioids.
A systemic review was recently published to explore its efficacy in managing pain after spine surgery. Studies suggest that whether used alone or in combination with other painkillers, ketorolac may benefit significantly those undergoing lumbar spine surgery. Moreover, ketorolac may be used along with opioids or other painkillers.
In the new study, researchers could identify 13 studies on the topic. In these studies, ketorolac was used either alone or along with medications like bupivacaine, morphine, epinephrine,acetaminophen, and pregabalin.
Researchers found that ketorolac was significantly better than placebo for pain control within six to 12 hours and 12 to 24 hours after spinal surgery. Further, they found it was particularly good for suppressing pain within the first six hours. However, its ability to reduce pain was less pronounced after six hours. So, after six hours, its effects started declining.
Additionally, ketorolac use could significantly reduce postoperative morphine requirements. Which means it could reduce the need for opioids.
Not only that but due to pain reduction and probably due to its anti-inflammatory properties, it could also reduce hospital stay duration a bit.
However, issues like nausea, vomiting, and constipation were as common in the ketorolac group as in the control group. Further, researchers cautioned that in some individuals, ketorolac may cause severe side effects like acute kidney injury, gastric bleeding, and anaphylaxis, something that must be kept in mind when using it for pain management.
Although study authors noted that ketorolac appears to be good for post-surgical pain control, they also noted that most studies on the topic had small sample sizes. Thus, there is a need for larger clinical trials to define its role in pain management in such 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
