Intravenous Meloxicam versus Ketorolac for Pain Control Following Total Joint Arthroplasty: A Double-Blind Randomized Controlled Trial.

Abstract

Although joint arthroplasty surgery is considered safe and effective in reducing osteoarthritis-related pain long-term, the surgery is known to be painful in the immediate postoperative period. Therefore, optimal pain management has become a crucial goal for orthopaedic surgeons. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used but can cause adverse effects due to their mechanism of action. Meloxicam, however, has a unique mechanism of action, allowing it to better spare the gut lining, translating to reduced complications. This double-blind randomized controlled trial sought to compare intravenous (IV) meloxicam and IV ketorolac for total joint arthroplasty regarding pain scores, opioid consumption, and lengths of stay. All other institutional protocols and medications remained unchanged. A total of 223 patients were randomized. The meloxicam group received 30 mg IV meloxicam preoperatively two hours before primary incision, while the ketorolac group received 15 mg IV ketorolac intraoperatively followed by 15 mg IV every six hours, scheduled for two doses. Pain, opioid consumption, and nausea were recorded at two and 24 hours postoperatively. An a priori power analysis demonstrated a need for 170 total patients. The study was registered on clinicaltrials.gov (NCT05291598) and received Institutional Review Board approval. The IV meloxicam group had increased total opioid consumption 24 hours postoperatively and longer lengths of stay compared to the IV ketorolac group; however, there were no differences in pain scores or nausea. The use of IV meloxicam as part of a perioperative pain management protocol led to increased opioid consumption, longer lengths of stay, and a lower rate of same-day discharges compared to IV ketorolac.