In this episode, I’ll discuss a systematic review of the ketorolac dose ceiling for ED analgesia.
Ketorolac is FDA approved for a dose of 30 mg IV for analgesia however there is extensive research dating back as far as 30 years that supports a ceiling dose in the 10 mg to 20 mg range for analgesic effect. This is important because the side effects for ketorolac probably increase in a dose dependent manner, so giving a dose above the ceiling effect for analgesia exposes a patient to risk of harm without any clinical benefit.
A group of authors recently published a systematic review in Annals of Emergency Medicine that covered 5 randomized controlled trials of low and standard ketorolac dosing in ED patients with acute pain.
A total of 627 patients were represented in the analysis.
The authors concluded with moderate certainty that a dose of 15 or 20 mg of IV ketorolac probably had no deleterious effect on pain scores when compared with a standard 30 mg IV dose.
Furthermore, a lower dose of 10 mg IV also probably had no deleterious effect on pain scores compared with a standard 30 mg dose; however, this conclusion was made with low certainty.
Finally, the low 10 mg dose might increase the need for breakthrough pain medication and might not result in fewer adverse effects.
The authors conclude that in adult ED patients with acute pain, ketorolac 10 mg to 20 mg IV is probably just as effective in relieving pain as doses of 30 mg IV or higher. The authors note this data is not generalizable to children or patients at higher risk of adverse events.
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