Assessment of Magnesium Sulfate Infusion in Combination with Ketorolac for the Pain Management in Intertrochanteric Fractures; A Randomized Clinical Trial

Abstract

Objectives: Intertrochanteric fracture is a common fracture that mainly occurs in the elderly. Diverse pain management strategies have been applied; however, considering the age of the patients, analgesia-related complications should be concisely considered. The current study aims to evaluate the efficacy and adverse effects of Ketorolac plus placebo versus Ketorolac plus magnesium sulfate for pain management in intertrochanteric fractures. Methods: The current randomized clinical trial has been conducted on 60 patients with intertrochanteric fractures assigned into two groups of treatment with Ketorolac (30 mg) plus placebo (n=30) versus Ketorolac (30 mg) plus magnesium sulfate (15 mg/kg) (n=30). Pain scores using the visual analog scale (VAS), hemodynamic parameters, and complications (nausea and vomiting) were assessed at baseline and within 20, 40, and 60 minutes after the interventions. Additional morphine sulfate requirements were compared between the groups. Results: Demographic characteristics in both groups were similar (P>0.05). All the assessments showed statistically significantly less pain severity in the magnesium sulfate/Ketorolac group (P<0.05), except for the baseline assessments (P=0.873). The two groups did not differ regarding hemodynamic parameters, nausea, and vomiting complaints (P>0.05). Although the frequency of additional morphine sulfate requirement was not different between the groups (P=0.06), the administered dose of morphine sulfate was significantly higher in those treated with ketorolac/placebo (P=0.002). Conclusion: Based on the findings of this study, Ketorolac alone or in combination with magnesium sulfate led to significant pain reduction in patients with intertrochanteric fractures admitted to the emergency ward; however, the combination therapy had superior outcomes. Further studies are strongly recommended. Level of evidence: II