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