Evidence map›Paper›PMID 40359133›Full record

ArticleJournal of the American Academy of Orthopaedic Surgeons. Global research & reviews2025

Postoperative Pain Management With Ketorolac, Acetaminophen, and Gabapentin in Femoral Shaft Fractures: A Prospective Cohort Study.

Hans Hess Arcelay, José I Acosta Julbe, Alexandra M Claudio-Marcano, Francis X Cedeño Rodriguez, Edgardo Martinez, Ruben Tresgallo, Norman Ramirez Lluch, Luis Lojo-Sojo

Abstract read
In one paragraph

Article in Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Hans Hess ArcelayFrom the Department of Orthopedic Surgery, University of Puerto, Río Piedras, Puerto Rico (Dr. Hess Arcelay, Dr. Acosta Julbe, Dr. Claudio-Marcano, Dr. Martinez, and Dr. Lojo-Sojo); the School of Medicine, University of Puerto Rico, San Juan, Puerto Rico (Mr. Cedeño Rodriguez); the Division of Arthroplasty, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA (Dr. Tresgallo); the Department of Orthopaedic Surgery, Mayagüez Medical Center, Mayagüez, Puerto Rico (Dr. Ramirez Lluch); and the School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico (Dr. Ramirez Lluch).
José I Acosta JulbeORCID 0009-0006-0765-2273
Alexandra M Claudio-Marcano
Francis X Cedeño Rodriguez
Edgardo Martinez
Ruben Tresgallo
Norman Ramirez Lluch
Luis Lojo-Sojo

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPostoperative pain management in orthopaedic trauma surgery is critical. Amid the opioid crisis, nonopioid analgesia offers a promising alternative. We aim to evaluate the feasibility of a multimodal regimen, including intravenous ketorolac, oral acetaminophen, and oral gabapentin, in managing postoperative pain after femur shaft fractures treated with intramedullary nailing.

methodsWe conducted a prospective cohort study to evaluate the postoperative pain of patients with isolated femur shaft fractures treated with intramedullary nailing. The experimental group consisted of 29 patients, while the control group consisted of 42 patients who received standard opioid-based pain management. The outcomes measured were the Visual Analog Scale (VAS) scores and the morphine milligram equivalents every 12 hours until 48 hours postoperatively.

resultsPatient demographics were comparable between the experimental and control groups, with a significant age difference (31 vs. 40; P = 0.002) but not in sex, body mass index, smoking status, or diabetes prevalence. We observed no significant differences in VAS scores at 12, 24, 36, and 48 hours after surgery. In addition, there was a marked reduction in opioid usage in the experimental group, with P-values < 0.001 at each time point.

conclusionThe study concludes that the coadministration of ketorolac, acetaminophen, and gabapentin is an effective opioid-sparing alternative for postoperative pain in isolated femur shaft fractures. Future research could benefit from a more diverse patient population in orthopaedic trauma to further validate our results and explore long-term outcomes. LEVEL OF EVIDENCE: Prospective Cohort Study; Level 2.

Indexed as

AcetaminophenAminesAnalgesicsAnalgesics, Non-NarcoticAnti-Inflammatory Agents, Non-SteroidalCyclohexanecarboxylic AcidsFemoral FracturesFracture Fixation, Intramedullarygamma-Aminobutyric AcidKetorolacPain ManagementPostoperative PainAdultAnalgesics, OpioidDrug Therapy, CombinationFemaleAcetaminophenAminesAnalgesicsAnalgesics, Non-NarcoticAnalgesics, OpioidAnti-Inflammatory Agents, Non-SteroidalCyclohexanecarboxylic AcidsGabapentingamma-Aminobutyric AcidKetorolac

Identifiers

PMID40359133
PMCPMC12063779

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.