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Head to Head: IM Ketorolac vs. Oral Ibuprofen

Ketorolac, the only parenteral nonsteroidal anti-inflammatory drug available in the U.S., has enjoyed much success since its release. But initial studies comparing ketorolac favorably to moderate-strength opioids have been criticized on the basis of design, and no study has convincingly shown its superiority over various oral NSAIDs.

This double-blind study from San Francisco General Hospital randomized a convenience sample of 119 ED patients with moderate-to-severe pain (5 to 8 on a self-rated 10-point scale) to 60 mg of ketorolac IM and oral placebo, or 800 mg of oral ibuprofen and IM placebo (saline). Pain sources varied, but patients with sickle-cell or migraine pain and those in resuscitation rooms were excluded. Pain was scored at baseline and 15, 30, 45, 60, 90, and 120 minutes after treatment. Scores improved in both groups, but 40% of patients did not have adequate analgesia at two hours with either drug. The groups did not differ in the degree of pain improvement, the need for supplemental analgesia (provided at physicians' discretion), or side effects.

Comment: This study adds to a growing body of literature showing that ketorolac provides no significant benefit over any other NSAID except that it can be given parenterally. Oral NSAIDs, if patients can take them, are much less expensive and seem just as effective. The inadequacy of analgesia in 40% of patients suggests that opioid supplementation will often be needed.

— DM Birnbaumer

Published in Journal Watch Emergency Medicine March 1, 1998

Citation(s):

Neighbor ML and Puntillo KA. Intramuscular ketorolac vs oral ibuprofen in emergency department patients with acute pain. Acad Emerg Med 1998 Feb 5 118-122.

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