UMEM Educational Pearls

Category: Pharmacology & Therapeutics

Title: Ketorolac's analgesic ceiling

Keywords: ketorolac, NSAID, analgesia (PubMed Search)

Posted: 1/7/2017 by Michelle Hines, PharmD (Updated: 4/26/2024)
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Question

In a study comparing ketorolac IV doses of 10 mg, 15 mg, and 30 mg, no difference in pain score reduction or need for rescue analgesia was observed.

Answer

Randomized, double-blind trial comparing the efficacy of ketorolac 10 mg, 15 mg, and 30 mg IV in adults aged 18 to 65 years presenting to the ED for acute abdominal, flank, headache, or musculoskeletal pain rated 5 or greater on a 0 to 10 numeric rating scale
The primary outcome was reduction in numeric rating scale pain score at 30 minutes. Pain scores, vital signs, and adverse effects were recorded at baseline and at 15, 30, 60, 90, and 120 minutes post-ketorolac administration.
Morphine 0.1 mg/kg IV was used as rescue analgesia at 30 minutes if needed.
A majority of patients included complained of abdominal, flank, or musculoskeletal pain.
At 30 minutes post-administration, there were no differences in reduction of mean pain scores from baseline between the 10 mg (baseline score 7.7, 30-minute score 5.2), 15 mg (baseline score 7.5, 30-minute score 5.1), or 30 mg (baseline score 7.8, 30-minute score 4.8) groups.

Based upon this study, lower ketorolac doses of 10 mg or 15 mg are equal in analgesic efficacy to a higher dose of 30 mg. A lower dose of 10 mg or 15 mg should be used to avoid adverse effects.

References

Motov S, Yasavolian M, Likourezos A, et al. Comparison of intravenous ketorolac at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial. Ann Emerg Med 2016. PMID 27993418

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