Comparing two doses of intramuscular ketorolac for treatment of acute musculoskeletal pain in a military emergency department - 30/11/21
, Drew A. Long a, b, Joseph R. Bongiorno a, b , Timothy P. Katoski a, b, c , Lisa M. Jin a, b , John Paul Horsch a, b, d, Brian J. Ahern a, bAbstract |
Study objective |
The goal of the study was to assess a low-dose versus a high-dose of intramuscular (IM) ketorolac for non-inferiority in adults with acute MSK pain in an emergency department (ED).
Methods |
This was a single-blinded, randomized controlled, non-inferiority trial of adults presenting to an ED with a chief complaint of acute MSK pain. Patients were randomized to either a 15 mg or a 60 mg IM ketorolac dose. The primary outcome was the mean difference of change in pain from baseline to 60-min between the two groups as reported on a 100-mm (mm) visual analog scale (VAS). Secondary outcomes included the mean difference of change in VAS scores at 30-min and the incidence of reported adverse effects associated with the administration of ketorolac.
Results |
One hundred ten patients were randomized with 55 in each group. The mean difference in pain between groups at 60-min (0.2 mm [95% CI -8.5–8.7]; p = .98) and 30 min (−1.7 mm [95% CI -8.5–5.1; p = .63) was less than the predetermined non-inferiority margin of 13 mm. There were no major adverse effects reported. Minor adverse effects were more frequent in the 60 mg group (n = 9; 16.4% vs. n = 1; 1.8%; p = .016) with burning at the injection site being the most commonly reported.
Conclusions |
A 15 mg dose of IM ketorolac was found to be non-inferior to a 60 mg dose for acute MSK pain in adults presenting to the ED. Discontinuing the practice of ordering 60 mg doses of IM ketorolac in place of a lower dose for acute MSK pain should be considered.
Le texte complet de cet article est disponible en PDF.Highlights |
• | 15 mg ketorolac was found to be non-inferior to 60 mg when administered intramuscularly for acute MSK pain in an ED. |
• | There was a statistically significant number of reportedminor adverse events with 60 mg compared to 15 mg. |
• | Patients with neck or back pain reported statistically significant less analgesia than any other group, regardless of dose. |
Keywords : Emergency department, Ketorolac, Musculoskeletal, Intramuscular, Analgesia, Pain control, Non-inferiority
Plan
Vol 50
P. 142-147 - décembre 2021 Retour au numéro
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