Ketorolac was as effective at reducing pain as other nonsteroidal anti-inflammatory drugs (NSAIDs) and superior to opioids following surgery. These findings from a systematic review and meta-analysis were published in the Cochrane Database of Systematic Reviews.
The investigators searched publication databases through April 2020 for studies that compared single-injection ketorolac with other NSAIDs, opioids, or placebo for surgical pain. A total of 12 studies comprising 1905 patients were included. Reduced pain was defined as a reduction in pain of 50% or more.
The studies compared ketorolac with placebo (n=11), other NSAIDs (n=6), and/or opioids (n=4). Trials were conducted in the US (n=8), Mexico (n=1), New Zealand (n=1), England (n=1), and Norway (n=1).
At 4 hours after surgery, ketorolac reduced pain among 57% (range, 35% to 82%) of patients compared with 19% of placebo recipients (range, 0% to 39%). At 6 hours, ketorolac reduced pain among 61% (range, 36% to 77%) of patients compared with 23% of placebo recipients (range, 0% to 55%).
The time to use of rescue medication was 271 minutes for ketorolac recipients and 104 minutes for placebo recipients.
At 4 hours after surgery, ketorolac reduced pain among 65% (range, 51% to 76%) of patients compared with 63% of recipients of other NSAIDs (range, 55% to 80%) and at 6 hours, among 66% (range, 46% to 77%) and 63% (range, 53% to 76%), respectively.
The proportion of patients requiring rescue medication was 48% for ketorolac and 52% for recipients of other NSAIDs.
At 4 hours after surgery, ketorolac reduced pain among 64% (range, 51% to 76%) of patients compared with 36% of opioid recipients (range, 26% to 55%). At 6 hours, ketorolac reduced pain among 58% (range, 46% to 71%) of patients compared with 30% of opioid recipients (range, 19% to 50%).
Rescue medication was administered to 61% and 79% of ketorolac and opioid recipients, respectively.
Adverse events were reported by 74% to 76% of patients who received 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 low level of confidence overall in these data.
These findings suggested a single dose of ketorolac is superior to opioids and placebo for decreasing pain after surgery, and its effectiveness is similar to that of other NSAIDs.
McNicol ED, Ferguson MC, Schumann R. Single-dose intravenous ketorolac for acute postoperative pain in adults. Cochrane Database Syst Rev. 2021;5(5):CD013263. doi:10.1002/14651858.CD013263.pub2