{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:59:14Z","timestamp":1792198754205,"version":"4.4.0"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["J Am Acad Orthop Surg","JAAOS"],"published-print":{"date-parts":[[2024,6,15]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective analgesics commonly used in fracture management. Although previously associated with delayed fracture healing, multiple studies have demonstrated their safety, with minimal risks of fracture healing. Given the current opioid crisis in the United States, alternate pain control modalities are essential to reduce opioid consumption. This study aims to determine whether the combination of oral acetaminophen and intravenous ketorolac is a viable alternative to opioid-based pain management in closed tibial shaft fractures treated with intramedullary nailing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a randomized controlled trial evaluating postoperative pain control and opioid consumption in patients with closed tibial shaft fractures who underwent intramedullary nailing. Patients were randomized into an NSAID-based pain control group (52 patients) and an opioid-based pain control group (44 patients). Visual analog scale (VAS) scores and morphine milligram equivalents (MMEs) were evaluated at 12-hour postoperative intervals during the first 48 hours after surgery. Nonunion and delayed healing rates were recorded for both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A statistically significant decrease in MMEs was noted at every measured interval (12, 24, 36, and 48 hours) in the NSAID group compared with the opioid group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      -value 0.001, 0.001, 0.040, 0.024, respectively). No significant change in visual analog scale scores was observed at 12, 36, and 48 hours between both groups (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      -value 0.215, 0.12, and 0.083, respectively). A significant decrease in VAS scores was observed at the 24-hour interval in the NSAID group compared with the opioid group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      -value 0.041). No significant differences in union rates were observed between groups (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      -value 0.820).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>Using an NSAID-based postoperative pain protocol led to a decrease in opioid consumption without affecting pain scores or union rates. Owing to the minimal risk of short-term NSAID use, their role in the perioperative management of tibia shaft fractures is justified, especially when they reduce opioid consumption markedly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence:<\/jats:title>\n                    <jats:p>Therapeutic Level I.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5435\/jaaos-d-23-01014","type":"journal-article","created":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T18:01:04Z","timestamp":1712340064000},"page":"e596-e604","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["Opioid-Sparing Nonsteroid Anti-inflammatory Drugs Protocol in Patients Undergoing Intramedullary Nailing of Tibial Shaft Fractures: A Randomized Control Trial"],"prefix":"10.5435","volume":"32","author":[{"given":"Hans","family":"Hess-Arcelay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4996-1729","authenticated-orcid":false,"given":"Alexandra","family":"Claudio-Marcano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norberto J.","family":"Torres-Lugo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Deliz-Jimenez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Acosta-Julbe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Hernandez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Deliz-Jimenez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gamaliel","family":"Monge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norman","family":"Ram\u00edrez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Lojo-Sojo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,4,4]]},"reference":[{"key":"R1-20250503","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1530\/EOR-22-0076","article-title":"Frequency of complications in intramedullary nailing of open tibial shaft fractures: A systematic review","volume":"8","author":"Turley","year":"2023","journal-title":"EFORT Open Rev"},{"key":"R2-20250503","doi-asserted-by":"crossref","first-page":"e24","DOI":"10.2106\/JBJS.ST.17.00063","article-title":"Intramedullary nail fixation of tibial shaft fractures: Suprapatellar approach","volume":"8","author":"Cereijo","year":"2018","journal-title":"JBJS Essent Surg Tech"},{"key":"R3-20250503","first-page":"3029","volume":"32","author":"Neal","year":"2018","journal-title":"HHS Public Access"},{"key":"R4-20250503","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.ocl.2017.06.002","article-title":"The effect of opioids, alcohol, and non-steroidal anti-inflammatory drugs on fracture union","volume":"48","author":"Richards","year":"2017","journal-title":"The Orthop Clin North America"},{"key":"R5-20250503","doi-asserted-by":"crossref","first-page":"3379","DOI":"10.1016\/j.arth.2018.07.002","article-title":"The opioid crisis and the orthopedic surgeon","volume":"33","author":"Trasolini","year":"2018","journal-title":"J Arthroplasty"},{"key":"R6-20250503","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1186\/s12891-022-05044-y","article-title":"Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: A scoping review","volume":"23","author":"C\u00f4t\u00e9","year":"2022","journal-title":"BMC Musculoskelet Disord"},{"key":"R7-20250503","doi-asserted-by":"crossref","first-page":"2290","DOI":"10.1016\/j.injury.2018.09.024","article-title":"Tibia fractures and NSAIDs. 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