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.


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

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