Contributor: Ricky Dhaliwal, MD
Educational Pearls:
Ketorolac and ibuprofen are NSAIDs with equivalent efficacy for pain in the emergency department
Oral ibuprofen provides the same relief as intramuscular ketorolac
IM ketorolac is associated with the adverse effect of a painful injection
IM ketorolac is slightly faster in onset but not significant
Studies have assessed the two medications in head-to-head randomized-controlled trials and found no significant difference in pain scores
IM ketorolac takes longer to administer and has a higher cost
Ketorolac dosing
Commonly given in 10 mg, 15 mg, and 30 mg doses
However, higher doses are associated with more adverse effects
Gastrointestinal upset, nausea, and bleeding risk
Studies have demonstrated equal efficacy in pain reduction with lower doses
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. 2017;70(2):177-184. doi:10.1016/j.annemergmed.2016.10.014
Neighbor ML, Puntillo KA. Intramuscular ketorolac vs oral ibuprofen in emergency department patients with acute pain. Acad Emerg Med. 1998;5(2):118-122. doi:10.1111/j.1553-2712.1998.tb02595.x
Summarized & Edited by Jorge Chalit, OMS3
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