A single injection of ketorolac is more effective than opioids in reducing surgical pain

Ketorolac was as effective as other post-operative nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids at relieving pain. These results from a systematic review and a meta-analysis were published in the Cochrane Database of Systematic Reviews.

Investigators searched publication databases through April 2020 for studies comparing ketorolac with a single injection to other NSAIDs, opioids, or placebo for surgical pain. A total of 12 studies with 1905 patients were included. Pain relief was defined as a pain reduction of 50% or more.

The studies compared ketorolac with placebo (n = 11), other NSAIDs (n = 6), and / or opioids (n = 4). Studies were conducted in the USA (n = 8), Mexico (n = 1), New Zealand (n = 1), England (n = 1) and Norway (n = 1).

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4 hours after surgery, ketorolac reduced pain in 57% (range 35 to 82%) of patients compared to 19% of placebo recipients (range 0 to 39%). After 6 hours, ketorolac reduced pain in 61% (range 36 to 77%) of patients compared to 23% of placebo recipients (range 0 to 55%).

The time to taking rescue medication was 271 minutes for ketorolac recipients and 104 minutes for placebo recipients.

4 hours after surgery, ketorolac reduced pain in 65% (range 51 to 76%) of patients compared to 63% of recipients of other NSAIDs (range 55 to 80%) and after 6 hours in 66% (range 46 to 77%) ) or 63% (range 53 to 76%).

The proportion of patients requiring rescue medication was 48% for ketorolac and 52% for recipients of other NSAIDs.

Four hours after surgery, ketorolac reduced pain in 64% (range 51 to 76%) of patients compared to 36% of opioid recipients (range 26 to 55%). After 6 hours, ketorolac reduced pain in 58% (range 46 to 71%) of patients compared to 30% of opioid recipients (range 19 to 50%).

61% of ketorolac and 79% of opioid recipients received emergency medication.

Adverse events were reported by 74% to 76% of patients receiving ketorolac, 65% for placebo, 68% for other NSAIDs, and 83% for opioids.

This review was limited by the small size of the underlying studies and the overall low confidence in these data.

These results suggest that a single dose of ketorolac opioids and placebo is superior to postoperative pain relief and its effectiveness is similar to that of other NSAIDs.

reference

McNicol ED, Ferguson MC, Schumann R. Single-use intravenous ketorolac for acute postoperative pain in adults. Cochrane Database Syst Rev. 2021; 5 (5): CD013263. doi: 10.1002 / 14651858.CD013263.pub2

This article originally appeared on Clinical Pain Advisor