SEPTEMBER 13, 2023
Recently published data indicate that a low dose of the nonsteroidal anti-inflammatory drug ketorolac may be as effective at relieving pain in an emergency department setting as higher doses.
“Ketorolac’s analgesic efficacy remains undeterred, even when administered at lower dosages, specifically within the 10-mg to 20-mg range. This finding posits that modest doses are at equal footing with their weightier counterpart of 30 mg or beyond, in terms of pain mitigation, signifying that
Recently published data indicate that a low dose of the nonsteroidal anti-inflammatory drug ketorolac may be as effective at relieving pain in an emergency department setting as higher doses.
“Ketorolac’s analgesic efficacy remains undeterred, even when administered at lower dosages, specifically within the 10-mg to 20-mg range. This finding posits that modest doses are at equal footing with their weightier counterpart of 30 mg or beyond, in terms of pain mitigation, signifying that maximal relief can be attained without venturing into the higher dosage terrain,” study author Mohamed Eltorki, MD, an associate professor of pediatrics at McMaster University, in Hamilton, Ontario, told Pain Medicine News.
The systematic review included 627 adult patients from five randomized controlled trials who were treated for acute pain in an emergency department setting (Ann Emerg Med 2023 May 13. doi:10.1016/j.annemergmed.2023.04.011).
Researchers determined with “moderate certainty” that when administering ketorolac at 15 to 20 mg compared with doses of at least 30 mg, there was no effect on participants’ pain scores (mean difference, 0.05 mm lower on 100-mm visual analog scale, 95% CI, -4.91 mm to +5.01 mm; moderate certainty).
There was no difference in adverse events recorded between patients who were administered ketorolac at high and low does, yet the trials excluded any patients with risk factors for ketorolac adverse events, a possible bias.
Eltorki warned that “most of the pain outcomes were assessed at one to two hours post-administration of ketorolac, and we found a slightly higher incidence of rescue therapy use in low-dose ketorolac compared to higher doses.” He concluded that further trials need to measure pain at six to eight hours after intervention and compare the use of rescue pain medicine to ensure that recipients of a lower dose do not require more rescue medication.
—Myles Starr
Eltorki reported no relevant financial disclosures.
