NSAIDs, gabapentinoids may not increase nonunion rates after orthopedic trauma injury
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TAMPA, Fla. — According to presented results, NSAIDs and gabapentinoids do not substantially increase nonunion rates; however, these may not improve pain control or decrease opioid utilization in orthopedic trauma patients.
“To avoid the negative effects of opioids, we need to identify new mechanisms to treat these patients,” Renan C. Castillo, MD, said in his presentation at the Orthopaedic Trauma Association Annual Meeting. “NSAIDs and gabapentinoids have be proposed as solutions to the problems we face; however, the effects of these medicines on orthopedic trauma outcomes – most importantly nonunion – have not been adequately studied.”
Castillo and colleagues in the Major Extremity Trauma Research Consortium (METRC) analyzed 435 patients (mean age of 40.6 years) who were randomized to one of three pain control protocols. Group one received a standard pain management plus placebo protocol (n = 148). Group two received a standard pain management plus NSAID protocol (n = 141). Group three received a standard pain management plus pregabalin protocol (n = 146). Interventions consisted of a single oral dose of placebo or 300 mg of pregabalin, and a single IV dose of either 50 mL saline or 30 mg of ketolorac in 50 mL saline up to 2 hours before surgery. After surgery, patients received either placebo or 75 mg of pregabalin every 6 hours for 48 hours.
According to the abstract, outcome measures included opioid utilization, pain intensity and surgery for nonunion. Fixation surgery was indicated for proximal humerus, distal humerus, supracondylar femur, femoral shaft, tibia plateau, tibia shaft, open ankle, tibia plafond, calcaneus, talus and midfoot fractures.
Overall, Castillo and colleagues found NSAIDs and gabapentinoids to be noninferior to the placebo for pain management and nonunion at 182 days and 365 days. The probability of nonunion was 0.0371 in the placebo group, 0.0474 in the NSAIDs group and 0.04409 in the gabapentinoids group. Researchers also found no differences in opioid utilization or brief pain inventory (BPI) interference scores. They noted the NSAID group had “consistently” higher mean and median BPI scores compared with the placebo group.
“Further trials testing higher dosages and lengths of treatment for these agents will be needed to establish whether pain and opioid outcomes can be improved without increasing nonunion,” Castillo concluded.
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Castillo RC, et al. Paper 85. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 12-15, 2022; Tampa, Fla.
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