Ketorolac and Spinal Fusion

Pradhan, Ben B.; Tatsumi, Robert L.; Gallina, Jason; Kuhns, Craig A.; Wang, Jeffrey C.; Dawson, Edgar G.

doi:10.1097/brs.0b013e31818396f4

Cited by 81 publications

(22 citation statements)

References 57 publications

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“…29,32,33 In adult clinical studies, both Glassman et al 34 and Park et al 36 demonstrated increased nonunion rates in patients undergoing posterior spinal fusion who used ketorolac postoperatively. But Pradhan et al 37 failed to demonstrate any difference.…”

Section: Discussionmentioning

confidence: 93%

“…Some human adult studies investigating the effects of the NSAID ketorolac on spinal fusion have demonstrated an inhibition to bone healing 34–36 but one larger clinical study did not. 37 The effect of NSAIDs on bone healing in human adults after fracture or osteotomy is less clear, with some studies demonstrating increased rates of nonunion with NSAID use, 38,39 whereas other studies finding no correlation. 40,41 …”

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confidence: 99%

“…Ketorolac was chosen because it is practically utilized in orthopaedic surgery, has been studied in both adults 34–37 and children, 4,42–45 and there is evidence that it delays bone formation in adult rats 13 and adult rabbits. 14,22,27 We hypothesized that the NSAID ketorolac would not lead to delayed union or failure of bone formation in healing tibia fractures in these juvenile rats.…”

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confidence: 99%

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Ketorolac Administration Does Not Delay Early Fracture Healing in a Juvenile Rat Model

Cappello

Nuelle

Katsantonis

et al. 2013

Journal of Pediatric Orthopaedics

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Background Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective at controlling pain in children, especially in the treatment of fractures. Adult animal and adult clinical studies demonstrate conflicting evidence for the inhibitory relationship between NSAIDs and fracture healing. Published pediatric orthopaedic clinical studies do not demonstrate an inhibitory effect of ketorolac on bone healing. Little is known about the effects of any NSAID on bone formation in juvenile animals. This study investigates the effects of the NSAID ketorolac on fracture healing in a juvenile rat model. Methods Unilateral surgically induced and stabilized tibial shaft fractures were created in 45 juvenile (3 to 4wk old) male Sprague-Dawley rats. Either ketorolac (5 mg/kg; n=24) or saline (0.9% normal saline; n=21) was then administered to the rats 6 d/wk by intraperitoneal injections. Animals were then randomly assigned into time groups and euthanized at 7 days (n=8 ketorolac, n=7 saline), 14 days (n=8 ketorolac, n=7 saline), or 21 days (n=8 ketorolac, n=7 saline) postfracture. Biomechanical analysis was performed using a custom-designed 4-point bending loading apparatus. Statistics for tibial stiffness and strength data were performed using software package Systat 11. Specimens were also evaluated histologically using hematoxylin and eosin staining. Results Strength and stiffness of all fractured tibiae increased over time from day 7 to day 21 regardless of treatment type. No statistical difference was found between the fractured tibiae strength or stiffness in the ketorolac or control-treated specimens at the same time point. In addition, the quality of the fracture callus was similar in both groups at each of the time points. Conclusions In this study of a juvenile rat model with a stabilized tibia fracture, fracture callus strength, stiffness, and histologic characteristics were not affected by the administration of ketorolac during the first 21 days of fracture healing. Clinical Relevance The absence of inhibitory effects of ketorolac on early juvenile rat fracture healing supports the clinical practice of utilizing NSAIDs for analgesia in children with long bone fractures.

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Section: Discussionmentioning

confidence: 93%

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confidence: 99%

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confidence: 99%

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Ketorolac Administration Does Not Delay Early Fracture Healing in a Juvenile Rat Model

Cappello

Nuelle

Katsantonis

et al. 2013

Journal of Pediatric Orthopaedics

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“…Some studies suggest that NSAIDs have no effect on union rates, [130, 132–135] while some others showed a dose-dependant inhibitory effect underlining that patients who continued to take NSAIDs for more than 3 months postoperatively showed significantly lower success rates [128]. Potential presence of bias can exist in these studies as well and it is unclear whether COX-2 selective NSAIDs do have an effect as the vast majority of these studies utilize ketorolac which is a high COX-1 inhibitor.…”

Section: Discussionmentioning

confidence: 99%

Do Nonsteroidal Anti-Inflammatory Drugs Affect Bone Healing? A Critical Analysis

Pountos

Georgouli

Calori

et al. 2012

The Scientific World Journal

232

161

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Nonsteroidal anti-inflammatory drugs (NSAIDs) play an essential part in our approach to control pain in the posttraumatic setting. Over the last decades, several studies suggested that NSAIDs interfere with bone healing while others contradict these findings. Although their analgesic potency is well proven, clinicians remain puzzled over the potential safety issues. We have systematically reviewed the available literature, analyzing and presenting the available in vitro animal and clinical studies on this field. Our comprehensive review reveals the great diversity of the presented data in all groups of studies. Animal and in vitro studies present so conflicting data that even studies with identical parameters have opposing results. Basic science research defining the exact mechanism with which NSAIDs could interfere with bone cells and also the conduction of well-randomized prospective clinical trials are warranted. In the absence of robust clinical or scientific evidence, clinicians should treat NSAIDs as a risk factor for bone healing impairment, and their administration should be avoided in high-risk patients.

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“…Barrow [43] pointed out that Bianchi VI 0 models of the universe give a better explanation of some of the cosmological problems like primordial helium abundance and they also isotropize in a special sense. Looking to the importance of Bianchi type VI 0 universes, many authors [44]− [48] have studied it in different context. Recently Bali et al [49] have obtained some LRS Bianchi type VI 0 cosmological models imposing two types of conditions over the free gravitational fields.…”

Section: Introduction and Motivationsmentioning

confidence: 99%

A class of new LRS Bianchi type-I perfect fluid universes with decaying vacuum energy density Λ

Pradhan

Jotania

2011

Indian J Phys

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A class of new LRS Bianchi type-I cosmological models with a variable cosmological term is investigated in presence of perfect fluid. A procedure to generate new exact solutions to Einstein's field equations is applied to LRS Bianchi type-I space-time. Starting from some known solutions a class of new perfect fluid solutions of LRS Bianchi type-I are obtained. The cosmological constant L is found to be positive and a decreasing function of time which is supported by results from recent supernovae Ia observations. The physical and geometric properties of spatially homogeneous and anisotropic cosmological models are discussed.

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Ketorolac and Spinal Fusion

Abstract: Use of ketorolac after spinal fusion surgery in humans, limited to 48 hours after surgery for adjunctive analgesia, has no significant effect on ultimate fusion rates.

Cited by 81 publications

References 57 publications

Ketorolac Administration Does Not Delay Early Fracture Healing in a Juvenile Rat Model

Ketorolac Administration Does Not Delay Early Fracture Healing in a Juvenile Rat Model

Do Nonsteroidal Anti-Inflammatory Drugs Affect Bone Healing? A Critical Analysis

A class of new LRS Bianchi type-I perfect fluid universes with decaying vacuum energy density Λ

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