IV Ketorolac and Pain After Spinal Fusion — An RCT to Use, but Thoughtfully

The findings here can help you, but be mindful — this drug can harm as well as help

What’s the Claim?

A randomized clinical trial found that q6 hour administration of ketorolac (Toradol) for 48 hours resulted lower total opioid usage compared to IV acetaminophen (Tylenol) or IV placebo over the 3 days following lumbar fusion (173 ± 157 mg of oral morphine equivalents versus 255 ± 179 mg versus 299 ± 179 mg, respectively).

The authors claimed lower pain scores based on statistical differences that are too small to be clinically meaningful, lower length of stay (again, with differences less than a day on 2- to 3-day hospital stays, this is not likely meaningful, either), and no reduction in the likelihood of fusion or increase in the frequencies of serious adverse events from use of ketorolac (an NSAID), which is a potentially misleading claim, because the study was badly underpowered to detect differences in those uncommon events.

Still, the reduction in opioid analgesic usage with Toradol was large, and so let's talk about what this really means. The finding is useful, but not exactly as it appears.

How’s It Stack Up?