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Just Enough Ketorolac

Rob Orman, MD and Anand Swaminathan, MD FAAEM

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How much ketorolac do you need to treat a patient’s pain? Historically, it’s been 60mg IM and 30 mg IV.  In press in the Annals of Emergency Medicine - Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial found that 10 mg IV was equal in analgesia to 15 and 30 mg. So is more better? In this case, probably not.

Shawn D. -

Great segment. Excellent topic and one that I've been trying to convince our analgesia committee to get onboard with (low dose ketorolac). Can you include the reference to the article? I believe the data was presented at SAEM this year but would be nice to review the article (and unfortunately I can't find it on pubmed).

Rob O -

Hey Shawn, so far unable to find on pubmed but here is a link to the full article on annals of em site

Shawn D. -

Perfect! Thank you.

Luis R. -

I usually use, 15 IV and 30 IM, I read an article before, which shows 7.5 mg IV hit close to the threshold of analgesia so doesn't matter if u give more is the same no difference in pain control and IM 15 mg also the same.

Kara B. -

Ketorolac is also available is a 15 mg/ml vial, so a little less waste there.

brendanC -

Who was tested?
Was there degree of pain control adequate in the treated condition
What were the conditions treated?
I give Tordaol for renalcolic that is refusing opioids .It help alot and I will not t change.
SIDE EFFECTS? it would take a massive trial to determine how important or common siode effects exist: MY guess is .................NONE. Err on the side of compassion and kindness. This whole topic is a joke in the real world. Come se us in the REAL WORLD

Rob O -

Hi Brendan, Thanks for writing in. I think this has real world implications in finding the therapeutic ceiling of a commonly used analgesic. The follow up question is whether the increasing doses above the maximally effective dose causes commensurate side effects. This study certainly doesn't address that quesiton

Xander Merboo -

There's side effects to ketorolac. Acute tubular necrosis. I've seen it several times 'in the real world'.

Seema M., M.D. -

In the original article, were any of the patients followed for greater than 120 minutes?
ie, how long-lasting was the pain relief?

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Just Enough Ketorolac Full episode audio for MD edition 3:10 min - 3 MB - M4A