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In the emergency department, opioids are considered safe analgesics for those suffering from undifferentiated abdominal pain.
Ketorolac exhibits a safety profile comparable to morphine, without escalating the risk of 72-hour hospitalization or invasive intervention in adults discharged from the emergency department with uncomplicated non-traumatic abdominal pain.
In the emergency department, opioids are considered safe analgesics for those suffering from undifferentiated abdominal pain. However, concerns persist regarding the use of ketorolac, a potent nonsteroidal anti-inflammatory drug (NSAID), because its strong anti-inflammatory effects may theoretically blunt peritoneal signs and mask evolving surgical abdominal emergencies.
This study determined whether the initial choice of analgesic—ketorolac or morphine—impacted the risk of severe adverse outcomes, including hospital admission or invasive intervention, among adults discharged from the emergency department.
Researchers conducted a retrospective cohort study at a tertiary medical center in Taiwan, including 18,428 adults treated between 2021 and 2023. To isolate the true effect of analgesic selection and minimize confounding by indication, strict exclusion criteria were applied, restricting the analysis to a highly selected population of adults with uncomplicated non-traumatic abdominal pain who were discharged from the emergency department. The study population (18,428 adults) included:
The primary outcome was the occurrence of hospital admission or invasive intervention during an unscheduled return visit within 72 hours after emergency department discharge. Secondary analyses evaluated:
To adjust for differences in baseline characteristics and reduce treatment-selection bias, investigators applied inverse probability of treatment weighting (IPTW) using propensity scores.
Ketorolac was not associated with an increased risk of severe adverse outcomes when compared to morphine. The odds of hospital admission during an unscheduled return visit within 72 hours were similar between the two groups (adjusted odds ratio [AOR], 0.88; 95% confidence interval [CI], 0.58–1.33). Similarly, ketorolac did not increase the likelihood of requiring an invasive intervention during a 72-hour return visit when compared with morphine (AOR, 1.16; 95% CI, 0.69–1.97).
Among patients who were subsequently readmitted, ketorolac was not related to a longer hospital length of stay than morphine. However, ketorolac use was statistically linked with higher total medical costs compared with morphine, although the abstract did not report numerical cost estimates.
Ketorolac was not linked with an increased risk of 72-hour hospitalization or invasive intervention compared with morphine in adults discharged with uncomplicated non-traumatic abdominal pain. It proved to be a safe opioid-sparing alternative for carefully selected, non-critically ill patients, although it was linked with higher medical costs among readmitted patients.
European Journal of Medical Research
Association of ketorolac vs morphine with severe adverse outcomes in non-traumatic abdominal pain among patients discharged from the emergency department in Taiwan: a propensity score-weighted analysis
Chi-Syuan Pan et al.
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