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Ketorolac provides analgesia comparable to opioids across multiple acute pain conditions in adults presenting to the emergency department.
A systematic review and meta-analysis of 40 randomized controlled trials (RCTs) found that ketorolac provides similar pain relief to opioids and several other analgesics, but does not demonstrate a consistent advantage over other nonsteroidal anti-inflammatory drugs (NSAIDs).
The evidence at a glance
Researchers reviewed 40 RCTs involving adults with acute pain treated in emergency departments (EDs). The studies covered:
The PubMed search included English-language studies published through February 2023.
How did ketorolac perform?
Ketorolac vs. other NSAIDs
Only 7 studies directly compared ketorolac with other NSAIDs, primarily ibuprofen or diclofenac. None illustrated clear superiority of ketorolac. The authors therefore emphasize an important evidence gap: direct, adequately powered comparisons between ketorolac and commonly used NSAIDs remain limited.
What does this mean for emergency care?
The findings position ketorolac as a nonopioid analgesic option for acute pain in adults in the ED, with analgesic potency broadly comparable to opioids across several pain ailments. However, the evidence does not show that ketorolac is consistently more effective than other NSAIDs. Further head-to-head trials are needed to clarify its comparative efficiency.
Clinical and Experimental Emergency Medicine
Ketorolac analgesia in the emergency department in adults: a systematic review and meta-analysis
Antimo Tessitore et al.
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