Assessment of Magnesium Sulfate Infusion in Combination with Ketorolac for the Pain Management in Intertrochanteric Fractures; A Randomized Clinical Trial | ||
The Archives of Bone and Joint Surgery | ||
مقاله 6، دوره 11، شماره 6، شهریور 2023، صفحه 414-420 اصل مقاله (689.99 K) | ||
نوع مقاله: RESEARCH PAPER | ||
شناسه دیجیتال (DOI): 10.22038/abjs.2023.64778.3109 | ||
نویسندگان | ||
Bijan Heidari1؛ Rasoul Salimi2؛ Hossein Saremi1؛ Mostafa Arab Ghahestani* 1 | ||
1Department of Orthopedics, School of Medicine, Besat Hospital, Hamadan, Iran | ||
2Department of Emergency Medicine, School of Medicine, Besat Hospital, Hamadan, Iran | ||
چکیده | ||
Objectives: Intertrochanteric fracture is a common fracture that mainly occurs in the elderly. Diverse pain management strategies have been applied; however, considering the age of the patients, analgesia-related complications should be concisely considered. The current study aims to evaluate the efficacy and adverse effects of Ketorolac plus placebo versus Ketorolac plus magnesium sulfate for pain management in intertrochanteric fractures. Methods: The current randomized clinical trial has been conducted on 60 patients with intertrochanteric fractures assigned into two groups of treatment with Ketorolac (30 mg) plus placebo (n=30) versus Ketorolac (30 mg) plus magnesium sulfate (15 mg/kg) (n=30). Pain scores using the visual analog scale (VAS), hemodynamic parameters, and complications (nausea and vomiting) were assessed at baseline and within 20, 40, and 60 minutes after the interventions. Additional morphine sulfate requirements were compared between the groups. Results: Demographic characteristics in both groups were similar (P>0.05). All the assessments showed statistically significantly less pain severity in the magnesium sulfate/Ketorolac group (P<0.05), except for the baseline assessments (P=0.873). The two groups did not differ regarding hemodynamic parameters, nausea, and vomiting complaints (P>0.05). Although the frequency of additional morphine sulfate requirement was not different between the groups (P=0.06), the administered dose of morphine sulfate was significantly higher in those treated with ketorolac/placebo (P=0.002). Conclusion: Based on the findings of this study, Ketorolac alone or in combination with magnesium sulfate led to significant pain reduction in patients with intertrochanteric fractures admitted to the emergency ward; however, the combination therapy had superior outcomes. Further studies are strongly recommended. Level of evidence: II | ||
کلیدواژهها | ||
Femur intertrochanteric fractures؛ Ketorolac؛ Magnesium sulfate؛ Pain | ||
مراجع | ||
1. Wennberg P, Norlin R, Herlitz J, Sarenmalm EK, Möller M. Preoperative pain management with nerve block in patients with hip fractures: a randomized, controlled trial. Int J Orthop Trauma Nurs. 2019; 33:35-43. doi.org/10.1016/j.ijotn.2018.11.003. 2. Sanzone AG. Current challenges in pain management in hip fracture patients. J Orthop Trauma. 2016; 30:S1-S5. doi: 10.1097/BOT.0000000000000562. 3. Dixon J, Ashton F, Baker P, Charlton K, Bates C, Eardley W. Assessment and early management of pain in hip fractures: the impact of paracetamol. Geriatr Orthop Surg Rehabil. 2018; 9:2151459318806443. doi.10.1177/2151459318806443. 4. Sieber FE, Zakriya KJ, Gottschalk A, et al. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Elsevier; 2010:18-26. doi.10.1177/2151459318806443. 5. Zanker J, Duque G. Rapid geriatric assessment of hip fracture. Clin Geriatr Med. 2017; 33(3):369-382. doi.org/10.1016/j.cger.2017.03.003. 6. Maxwell L, White S. Anaesthetic management of patients with hip fractures: an update. Continuing Education in Anaesthesia, Critical Care & Pain. 2013; 13(5):179-183. doi.org/10.1093/bjaceaccp/mkt006. 7. Rantala M, Kankkunen P, Kvist T, Hartikainen S. Postoperative pain management practices in patients with dementia-the current situation in Finland. Open Nurs J. 2012; 6:71. doi: 10.2174/1874434601206010071. 8. Garlich JM, Pujari A, Moak Z, et al. Pain management with early regional anesthesia in geriatric hip fracture patients. J Am Geriatr Soc. 2020; 68(9):2043-2050. doi.org/10.1111/jgs.16547. 9. Edlund MJ, Steffick D, Hudson T, Harris KM, Sullivan M. Risk factors for clinically recognized opioid abuse and dependence among veterans using opioids for chronic non-cancer pain. Pain. 2007; 129(3):355-362. doi.org/10.1016/j.pain.2007.02.014. 10. Chau DL, Walker V, Pai L, Cho LM. Opiates and elderly: use and side effects. Clin Interv Aging. 2008; 3(2):273. 11. Lindenhovious AL, Helmerhorts GT, Schnellen AC, Vrahas M, Ring D, Kloen P. Differences in prescription of narcotic pain medication after operative treatment of hip and ankle fractures in the United States and The Netherlands. . J Trauma. 2009; 67(1):160-164. doi: 10.1097/TA.0b013e31818c12ee. 12. Abdolrazaghnejad A, Banaie M, Tavakoli N, Safdari M, Rajabpour-Sanati A. Pain management in the emergency department: a review article on options and methods. Adv J Emerg Med. 2018; 2(4). doi: 10.22114/AJEM.v0i0.93. 13. Haddadian A, Pourmoteabed S, Nasiri Gigloo K, Ghorbani Amjad G, Bahrami A. Comparison of Ketorolac and Ibuprofen IV Infusion Effect on Radius Distal Fracture Pain Control. Avicenna Journal of Clinical Medicine. 2018; 25(2):79-84. doi. 10.21859/ajcm.25.2.79. 14. McDonald E, Winters B, Nicholson K, et al. Effect of postoperative ketorolac administration on bone healing in ankle fracture surgery. Foot Ankle Int. 2018; 39(10):1135- 1140. doi.org/10.1177/1071100718782489. 15. Eftekharian HR. Effect of intravenous ketorolac on postoperative pain in mandibular fracture surgery; a randomized, double-blind, placebo-controlled trial. Bull Emerg Trauma. 2017; 5(1):13. 16. Sedighinejad A, Haghighi M, Nabi BN, et al. Magnesium sulfate and sufentanil for patient-controlled analgesia in orthopedic surgery. Anesth Pain Med. 2014; 4(1). doi: 10.5812/aapm.11334. 17. Bolcal C, Iyem H, Sargin M, et al. Comparison of magnesium sulfate with opioid and NSAIDs on postoperative pain management after coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2005; 19(6):714-718. doi.org/10.1053/j.jvca.2005.08.010. 18. Fan X, Cao F, Luo A. Femoral nerve block versus fascia iliaca block for pain control in knee and hip arthroplasties: A metaanalysis. Medicine (Baltimore). 2021; 100(14). doi: 10.1097/MD.0000000000025450. 19. Maleki Verki M, Porozan S, Motamed H, Fahimi MA, Aryan A. Comparison the analgesic effect of magnesium sulphate and Ketorolac in the treatment of renal colic patients: Doubleblind clinical trial study. Am J Emerg Med. 2019; 37(6):1033- 1036. doi:10.1016/j.ajem.2018.08.040. 20. Griffioen MA, O'Brien G. Analgesics administered for pain during hospitalization following lower extremity fracture: a review of the literature. J Trauma Nurs. 2018; 25(6):360- 365.doi: 10.1097/JTN.0000000000000402. 21. Molina-Praena J, Ramirez-Baena L, Gómez-Urquiza JL, Cañadas GR, De la Fuente EI, Cañadas-De la Fuente GA. Levels of burnout and risk factors in medical area nurses: A metaanalytic study. Int J Environ Res Public Health. 2018; 15(12):2800. doi.org/10.3390/ijerph15122800. 22. Aliuskevicius M, Østgaard SE, Rasmussen S. No influence of ibuprofen on bone healing after Colles’ fracture–A randomized controlled clinical trial. Injury. 2019; 50(7):1309-1317. doi.org/10.1016/j.injury.2019.06.011. 23. Cowan R, Lim JH, Ong T, Kumar A, Sahota O. The challenges of anaesthesia and pain relief in hip fracture care. Drugs Aging. 2017; 34(1):1-11. doi.org/10.1007/s40266-016-0427-5. 24. Sousa AM, Rosado GM, Neto JdS, Guimarães GM, Ashmawi HA. Magnesium sulfate improves postoperative analgesia in laparoscopic gynecologic surgeries: a double-blind randomized controlled trial. J Clin Anesth. 2016; 34:379-384. 25. Tramer MR, Schneider J, Marti R-A, Rifat K. Role of magnesium sulfate in postoperative analgesia. Anesthesiologists. 1996; 84(2):340-347. doi.org/10.1097/00000542-199602000-00011. 26. De Oliveira Jr GS, Castro-Alves LJ, Khan JH, McCarthy RJ. Perioperative systemic magnesium to minimize postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology. 2013; 119(1):178-190. doi.org/10.1097/ALN.0b013e318297630d. 27. Albrecht E, Kirkham K, Liu S, Brull R. Peri‐operative intravenous administration of magnesium sulphate and postoperative pain: a meta‐analysis. Anaesthesia. 2013; 68(1):79-90. doi.org/10.1111/j.1365-2044.2012.07335.x. 28. Stomatology FM, Yan Q. Effects of systemic magnesium on post-operative analgesia: is the current evidence strong enough. Pain Physician. 2015; 18:405-417. 29. Peng Y-N, Sung F-C, Huang M-L, Lin C-L, Kao C-H. The use of intravenous magnesium sulfate on postoperative analgesia in orthopedic surgery: A systematic review of randomized controlled trials. Medicine (Baltimore). 2018; 97(50). doi: 10.1097/MD.0000000000013583. 30. Hwang J-Y, Na H-S, Jeon Y-T, Ro Y-J, Kim C-S, Do S-H. IV infusion of magnesium sulphate during spinal anaesthesia improves postoperative analgesia. Br J Anaesth. 2010; 104(1):89-93. doi.org/10.1093/bja/aep334. 31. Arcioni R, Palmisani S, Tigano S, et al. Combined intrathecal and epidural magnesium sulfate supplementation of spinal anesthesia to reduce post‐operative analgesic requirements: a prospective, randomized, double‐blind, controlled trial in patients undergoing major orthopedic surgery. Acta Anaesthesiol Scand. 2007; 51(4):482-489. doi.org/10.1111/j.1399-6576.2007.01263.x. 32. Barata I, Spencer R, Suppiah A, Raio C, Ward MF, Sama A. Emergency ultrasound in the detection of pediatric long-bone fractures. Pediatr Emerg Care. 2012; 28(11):1154-1157. doi: 10.1097/PEC.0b013e3182716fb7. 33. Navali M, Mohammad A, Moradi M, Mokhtari M. Intra-Articular Injection of Ketorolac for Post-Arthroscopic Pain Control. Iranian Journal of Orthopedic Surgery. 2020; 13(1):16-21. doi.10.22034/ijos.2020.121285. 34. Verki MM, Porozan S, Motamed H, Fahimi MA, Aryan A. Comparison the analgesic effect of magnesium sulphate and Ketorolac in the treatment of renal colic patients: Doubleblind clinical trial study. Am J Emerg Med. 2019; 37(6):1033- 1036. doi.org/10.1016/j.ajem.2018.08.040. | ||
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