Comparing the efficacy of pethidine and ketorolac in managing postoperative pain following orthopedic fracture surgery in addicts: a prospective clinical study

Objectives: Effective postoperative pain management in patients with substance use disorder undergoing orthopedic surgery remains challenging. This study aimed to compare the analgesic efficacy and safety of pethidine and ketorolac in this specific population. Methods: In this prospective comparative study, 62 patients with substance use disorder undergoing orthopedic fracture repair were randomized into two groups. The ketorolac group (n = 31) received 30 mg intravenous ketorolac every 6 hours (maximum 120 mg/24 hours), while the pethidine group (n = 31) received 50 mg intravenous pethidine every 6 hours (maximum 200 mg/24 hours). Pain intensity was assessed using Visual Analog Scale (VAS) at baseline, 30 minutes, 1 hour, and 24 hours postoperatively. Results: Demographic characteristics, fracture patterns, and substance use profiles were comparable between groups. Both groups showed significant pain reduction from baseline to 24 hours postoperatively. The mean reduction in VAS scores was 4.0 ± 1.15 in the ketorolac group and 4.25 ± 0.99 in the pethidine group (P = 0.35). No significant differences in analgesic efficacy were observed at any time point. Both medications were well-tolerated with no reported adverse effects. Conclusion: Both pethidine and ketorolac provided effective postoperative analgesia in patients with substance use disorder undergoing orthopedic fracture surgery, with comparable efficacy and safety profiles. The choice between these analgesics should consider individual patient characteristics and potential for substance misuse.