A Phase 4 interventional study of Intravenous ketorolac and oral acetaminophen and Intravenous morphine and oral oxycodone in Femur Fracture and Tibial Fractures, sponsored by University of Puerto Rico. Completed at 1 site in Puerto Rico. Open to participants aged 18 Years to 110 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2025-03-04.
Sponsored by University of Puerto Rico · Phase 4, Interventional, and Treatment
The purpose of this trial is to determine whether oral acetaminophen and intravenous ketorolac are viable alternatives to opioid medication regimens for the pain management of patients with tibial and femoral shaft fractures treated with intramedullary nailing. This study will explore an alternative for opioid medications for patients undergoing intramedullary nailing of tibial and femoral shaft fractures.
The data analysis for the study will be performed separately for patients with femoral fractures and for patients with tibial fractures. Therefore, the data analysis will compare patients with femoral fractures receiving the experimental treatment to patients with femoral fractures receiving the control treatment (Group 1 vs. Group 2). Likewise, patients with tibial fractures receiving the experimental treatment will be compared to patients with tibial fractures receiving the control treatment (Group 3 vs. Group 4).
2,261 studies on the registry are indexed under Fractures, Bone; 325 are open to participants now.
This study's enrollment of 167 is above the median of 69 across 1,482 interventional studies indexed under Fractures, Bone.
Browse Fractures, Bone studies →University of Puerto Rico is the lead sponsor of 45 studies on the registry; 15 are open to participants now.
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Exclusion Criteria:
Group 1 will be composed of tibial fracture patients receiving the following standard pain control protocol: ketorolac 30 mg intravenous (IV) every 6 hours for patients younger than 70 years versus ketorolac 15 mg IV every 6 hours for patients older than 70 years, first dose will be administered 30 minutes preoperatively. An additional 1000mg of oral acetaminophen will be administered every 6 hours simultaneously regardless of the age group. Patients who determine pain to be unbearable and wish to opt out of the non-opioid group will receive may do so.
Drug: Intravenous ketorolac and oral acetaminophen
Group 2 will be composed of tibial fracture patients receiving the following pain control protocol: morphine 0.1 mg per kg intravenous every 6 hours with an additional oral oxycodone combined with acetaminophen 2 tabs every 6 hours.
Drug: Intravenous morphine and oral oxycodone
Group 3 will be composed of femoral fracture patients receiving the following standard pain control protocol: ketorolac 30 mg intravenous (IV) every 6 hours for patients younger than 70 years versus ketorolac 15 mg IV every 6 hours for patients older than 70 years, first dose will be administered 30 minutes preoperatively. An additional 1000mg of oral acetaminophen will be administered every 6 hours simultaneously regardless of the age group. Patients who determine pain to be unbearable and wish to opt out of the non-opioid group will receive may do so.
Drug: Intravenous ketorolac and oral acetaminophen
Group 4 will be composed of femoral fracture patients receiving the following pain control protocol: morphine 0.1 mg per kg intravenous every 6 hours with an additional oral oxycodone combined with acetaminophen 2 tabs every 6 hours.
Drug: Intravenous morphine and oral oxycodone
ketorolac 30 mg intravenous (IV) every 6 hours for patients younger than 70 years versus ketorolac 15 mg IV every 6 hours for patients older than 70 years, first dose will be administered 30 minutes preoperatively. An additional 1000mg of oral acetaminophen will be administered every 6 hours simultaneously regardless of the age group
Morphine 0.1 mg per kg intravenous every 6 hours with an additional oral oxycodone combined with acetaminophen 2 tabs every 6 hours.
12hrs VAS Pain Scores
Visual Analog Scale; 0-10 (10 indicates highest degree of pain)
Time frame: Measured at postoperative hour 12
24hrs VAS Pain Score
Visual Analog Scale; 0 to 10 (10 indicates highest degree of pain)
Time frame: Measured at postoperative hour 24
36hrs VAS Pain Scores
Visual Analog Scale; 0-10 (10 indicates highest degree of pain)
Time frame: Measured at postoperative hour 36
48hrs VAS Pain Scores
Visual Analog Scale; 0-10 (10 indicates highest degree of pain)
Time frame: Measured at postoperative hour 48
12hrs MME
Opioid consumption at postoperative hour 12. Reported as Morphine Milligram Equivalents (MME)
Time frame: Measured at postoperative hour 12
24hrs MME
Opioid consumption at postoperative hour 24. Reported as Morphine Milligram Equivalents (MME)
Time frame: Measured at postoperative hour 24
36hrs MME
Opioid consumption at postoperative hour 36. Reported as Morphine Milligram Equivalents (MME)
Time frame: Measured at postoperative hour 36
48hrs MME
Opioid consumption at postoperative hour 48. Reported as Morphine Milligram Equivalents (MME)
Time frame: Measured at postoperative hour 48
Hospital Length of Stay
Time from intervention to discharge
Time frame: Determined by discharge date
| Milestone | Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone |
|---|---|---|---|---|
| Started | 52 | 44 | 29 | 42 |
| Completed | 52 | 44 | 29 | 42 |
| Not completed | 0 | 0 | 0 | 0 |
Visual Analog Scale; 0-10 (10 indicates highest degree of pain)
| score on a scale | Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone |
|---|---|---|---|---|
| 12hrs VAS Pain Scores | 7.6 ± 2.20 | 7.9 ± 2.01 | 7.3 ± 2.5 | 7.2 ± 2.0 |
Visual Analog Scale; 0 to 10 (10 indicates highest degree of pain)
| score on a scale | Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone |
|---|---|---|---|---|
| 24hrs VAS Pain Score | 4.9 ± 2.5 | 5.9 ± 2.6 | 5.4 ± 2.6 | 5.1 ± 2.4 |
Visual Analog Scale; 0-10 (10 indicates highest degree of pain)
| score on a scale | Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone |
|---|---|---|---|---|
| 36hrs VAS Pain Scores | 4.9 ± 2.5 | 5.63 ± 2.3 | 5.3 ± 1.8 | 5.6 ± 2.3 |
Visual Analog Scale; 0-10 (10 indicates highest degree of pain)
| score on a scale | Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone |
|---|---|---|---|---|
| 48hrs VAS Pain Scores | 3.6 ± 2.01 | 4.3 ± 2.6 | 4.0 ± 1.6 | 3.4 ± 2.2 |
Opioid consumption at postoperative hour 12. Reported as Morphine Milligram Equivalents (MME)
| Morphine Milligram Equivalents (MME) | Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone |
|---|---|---|---|---|
| 12hrs MME | 2.9 ± 7.5 | 8.5 ± 10.1 | 2.9 ± 4.5 | 12.1 ± 11.6 |
Opioid consumption at postoperative hour 24. Reported as Morphine Milligram Equivalents (MME)
| Morphine Milligram Equivalents (MME) | Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone |
|---|---|---|---|---|
| 24hrs MME | 9.2 ± 18.6 | 21.49 ± 22.4 | 10.4 ± 13.6 | 28.8 ± 20.6 |
Opioid consumption at postoperative hour 36. Reported as Morphine Milligram Equivalents (MME)
| Morphine Milligram Equivalents (MME) | Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone |
|---|---|---|---|---|
| 36hrs MME | 14.1 ± 25.9 | 29.5 ± 29.9 | 15.7 ± 15.9 | 36.6 ± 29.1 |
Opioid consumption at postoperative hour 48. Reported as Morphine Milligram Equivalents (MME)
| Morphine Milligram Equivalents (MME) | Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone |
|---|---|---|---|---|
| 48hrs MME | 18.3 ± 33.3 | 37.2 ± 37.8 | 20.1 ± 21.0 | 48.0 ± 35.6 |
Time from intervention to discharge
| Days | Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone |
|---|---|---|---|---|
| Hospital Length of Stay | 1.9 ± 0.61 | 2.00 ± 0.89 | 1.8 ± 0.5 | 1.9 ± 1.1 |
Collected over 9 months. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | 0/52 (0%) | 2/52 (3.8%) | 0/52 (0%) |
| Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | 0/46 (0%) | 3/46 (6.5%) | 0/46 (0%) |
| Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | 0/29 (0%) | 7/29 (24.1%) | 0/29 (0%) |
| Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | 0/42 (0%) | 8/42 (19%) | 0/42 (0%) |
| Event | Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone |
|---|---|---|---|---|
| Delayed UnionMusculoskeletal and connective tissue disorders | 0/52 | 0/46 | 5/29 | 6/42 |
| Non-UnionMusculoskeletal and connective tissue disorders | 2/52 | 3/46 | 2/29 | 2/42 |
| Age, Continuous(Years) | Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Total |
|---|---|---|---|---|---|
| Median | 31 (23 to 42) | 40 (27 to 60) | 31 (23 to 42) | 40 (27 to 60) | 36 (24 to 55) |
| Sex: Female, Male(Participants) | Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Total |
|---|---|---|---|---|---|
| Female | 7 | 10 | 6 | 13 | 36 |
| Male | 45 | 34 | 23 | 29 | 131 |
| Race and Ethnicity Not Collected(Participants) | Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Total |
|---|---|---|---|---|---|
| Count of participants | — | — | — | — | 0 |
| Body Mass Index (BMI)(Kg/m^2) | Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Total |
|---|---|---|---|---|---|
| Mean | 26.6 ± 5.90 | 26.9 ± 6.21 | 27.1 ± 7.1 | 26.7 ± 6.2 | 26.8 ± 6.3 |
| Smoker status(Participants) | Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Total |
|---|---|---|---|---|---|
| Smoker | 13 | 12 | 6 | 13 | 44 |
| Non-smoker | 39 | 32 | 23 | 29 | 123 |
| Diabetes Status(Participants) | Group 1: Tibial Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 2: Tibial Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Group 3: Femoral Fracture Patients Receiving Intravenous Ketorolac and Oral Acetaminophen | Group 4: Femoral Fracture Patients Receiving Intravenous Morphine and Oral Oxycodone | Total |
|---|---|---|---|---|---|
| Yes | 5 | 5 | 3 | 8 | 21 |
| No | 47 | 39 | 26 | 34 | 146 |
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University of Puerto Rico