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

1. 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

2. 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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