Intramuscular ketorolac 15 mg and 60 mg are comparable for acute musculoskeletal pain relief

Reference

Turner NJ, Long DA, Bongiorno JR, et al. Comparing two doses of intramuscular ketorolac for treatment of acute musculoskeletal pain in a military emergency department. Am J Emerg Med 2021;50:142-147.

Synopsis

This noninferiority study took place in the emergency department of a single Defense Health Agency facility. The authors recruited a convenience sample of mostly active military men presenting with acute onset (< 30 days) musculoskeletal pain with an intensity at least 20 on a 100-mm visual analog pain scale. The participants randomly received either 15 mg (n = 55) or 60 mg (n = 55) intramuscular ketorolac. The study protocol allowed for rescue medication as determined by the treating clinician. The average baseline pain score was 68 for all participants. The average pain relief was a clinically meaningful reduction of 29.7 mm for the 15-mg group and 29.9 mm for the 60-mg group at 60 minutes after the injections. The authors do not describe the use of rescue analgesia. The participants in the higher-dose group reported slightly more frequent minor adverse events (16.4% vs 1.8%); injection site burning was the most common. Despite the small numbers of participants, the authors performed some subgroup analyses and report that those with neck or back pain (representing 34% of the study participants) had less relief regardless of dose.