What dose Ketorolac?

Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial Motov, Sergey et al. Annals of Emergency Medicine 2016 Dec.

Study Design:

  • N = 240, 18-65 years
  • Randomised to receive 10mg, 15mg, 30mg IV ketorolac as single dose (double blinded)
  • Acute flank, abdominal, MSK or headache pain with intensity > 5/10
  • Pain scores, vital signs, adverse effects recorded at baseline, 15, 30, 60, 90, 120 minutes
  • Subjects still desiring pain medication 30mins after study drug administration were offered IV morphine 0.1mg/kg as a rescue

Excluded

  • Age > 65
  • Pregnancy or breastfeeding
  • Active peptic ulcer disease
  • Acute GI haemorrhage
  • Known renal or hepatic insufficiency
  • Allergy to NSAIDs
  • Unstable vital signs
  • Patients that had already received an analgesic

Results

  • There was no difference in reduction of pain scores between the groups

–10 mg – 7.7 to 5.2

–15 mg – 7.5 to 5.1

–30 mg – 7.8 to 4.8

  • No different in the use of rescue morphine
  • No clinically concerning change in vital signs and no clinically significant adverse effects related to the study medication at any dose
  • No placebo group

Conclusions

  • Ketorolac has similar analgesic efficacy at IV doses of 10, 15 and 30mg
  • The ceiling dose of 10mg provides effective pain relief to ED patients with moderate to severe pain without increased adverse effects