Post-Op Pain Control for Prophylactic Intramedullary Nailing.

Nationally, the opioid crisis has become a major epidemic with increasing mortality rates
each year. Orthopedic surgeons routinely prescribe narcotics instead of NSAIDs for post-op
pain control because of risk of delayed healing and nonunion due to NSAID use. Orthopedic
oncology, however, has a unique subset of patients that undergo prophylactic placement of
intramedullary femoral nails, often due to bone metastases that increase risk for future
fractures. Because no fracture is present, these patients do not rely on inflammatory healing
factors, allowing for post-op NSAID use.

Recent literature has demonstrated the efficacy of multi-modal pain management in treating
post-op pain [1]. Currently, patients that undergo prophylactic intramedullary femur nail
placement at SLU are often treated with both narcotics and toradol, as long as they can
tolerate NSAIDs. However, the effect of toradol in addition to narcotics has not been
determined. This study sets out to determine the effect of post-op toradol use in addition to
opioids compared to solely opioids in patients undergoing prophylactic nailing of the femur.

Inclusion Criteria:

1. Femoral Shaft or Neck bone lesion

2. 18 years old or greater

3. Plan to undergo prophylactic intramedullary nailing of one or both femurs

Exclusion Criteria:

1. Concurrent pathologic fracture

2. History of advanced renal impairment

3. History of Peptic Ulcer Disease

4. History of NSAID or aspirin allergy

5. Concurrent chemotherapy regimen that prevents NSAID use

6. History of liver disease that precludes use of toradol

7. History of heart failure or cardiovascular disease

8. Pregnancy

9. History of opioid allergy that prevents used of opioids

10. Patients with coagulation disorders or those who require concomitant use of
anticoagulant or anti- platelet therapy during the treatment phase of the study.

11. Patients with acetaminophen allergies.

12. Current use of the medication probenecid

13. Current use of the medication Pentoxifylline

14. History of aspirin induced asthma.

15. History of coronary artery bypass graft

16. Known history of opioid dependence, abuse, or addiction.