Ketorolac - A Little Dab'll Do Ya

Short Attention Span Summary

A little dab'll do ya
Ketorolac IV is a good non-narcotic analgesic, often given at a dose of 30mg.  This RCT found that doses of 10mg, 15mg, and 30mg had equal pain relief.  There was no advantage to the larger dose.

Spoon Feed
For analgesia, there was no difference in 10mg, 15mg, and 30mg of IV ketorolac.  For a hilarious old commercial about "a little dab'll do ya," see this.


Abstract

Ann Emerg Med. 2016 Dec 14. pii: S0196-0644(16)31244-6. doi: 10.1016/j.annemergmed.2016.10.014. [Epub ahead of print]

Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial.

Motov S1, Yasavolian M2, Likourezos A2, Pushkar I2, Hossain R2, Drapkin J2, Cohen V3, Filk N4, Smith A5, Huang F2, Rockoff B2, Homel P6, Fromm C2.

Author information:

1Department of Emergency Medicine, Maimonides Medical Center. Electronic address: smotov@maimonidesmed.org.

2Department of Emergency Medicine, Maimonides Medical Center.

3Department of Pharmacy, New York City Health + Hospitals, Brooklyn, NY.

4Department of Pharmacy, Maimonides Medical Center.

5Department of Pharmacy, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.

6Office of Research Administration, Maimonides Medical Center, Brooklyn, NY; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY.

Abstract

STUDY OBJECTIVE:

Nonsteroidal anti-inflammatory drugs are used extensively for the management of acute and chronic pain, with ketorolac tromethamine being one of the most frequently used parenteral analgesics in the emergency department (ED). The drugs may commonly be used at doses above their analgesic ceiling, offering no incremental analgesic advantage while potentially adding risk of harm. We evaluate the analgesic efficacy of 3 doses of intravenous ketorolac in ED patients with acute pain.

METHODS:

We conducted a randomized, double-blind trial to assess the analgesic efficacy of 3 doses of intravenous ketorolac (10, 15, and 30 mg) in patients aged 18 to 65 years and presenting to the ED with moderate to severe acute pain, defined by a numeric rating scale score greater than or equal to 5. We excluded patients with peptic ulcer disease, gastrointestinal hemorrhage, renal or hepatic insufficiency, allergies to nonsteroidal anti-inflammatory drugs, pregnancy or breastfeeding, systolic blood pressure less than 90 or greater than 180 mm Hg, and pulse rate less than 50 or greater than 150 beats/min. Primary outcome was pain reduction at 30 minutes. We recorded pain scores at baseline and up to 120 minutes. Intravenous morphine 0.1 mg/kg was administered as a rescue analgesic if subjects still desired additional pain medication at 30 minutes after the study drug was administered. Data analyses included mixed-model regression and ANOVA.

RESULTS:

We enrolled 240 subjects (80 in each dose group). At 30 minutes, substantial pain reduction was demonstrated without any differences between the groups (95% confidence intervals 4.5 to 5.7 for the 10-mg group, 4.5 to 5.6 for the 15-mg group, and 4.2 to 5.4 for the 30-mg group). The mean numeric rating scale pain scores at baseline were 7.7, 7.5, and 7.8 and improved to 5.1, 5.0, and 4.8, respectively, at 30 minutes. Rates of rescue analgesia were similar, and there were no serious adverse events. Secondary outcomes showed similar rates of adverse effects per group, of which the most common were dizziness, nausea, and headache.

CONCLUSION:

Ketorolac has similar analgesic efficacy at intravenous doses of 10, 15, and 30 mg, showing that intravenous ketorolac administered at the analgesic ceiling dose (10 mg) provided effective pain relief to ED patients with moderate to severe pain without increased adverse effects.

Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

PMID: 27993418 [PubMed - as supplied by publisher]