Patterns of Ketorolac dosing by emergency physicians

Area of Science:

• Emergency Medicine
• Pharmacology
• Pain Management

Background:

• Ketorolac tromethamine is a widely used non-steroidal anti-inflammatory drug (NSAID) in emergency departments for moderate-to-severe pain.
• NSAIDs, including ketorolac, have an analgesic ceiling effect, with 10 mg suggested as a potential ceiling dose.
• Investigating physician dosing patterns relative to the established ceiling dose is crucial for optimizing pain management.

Purpose of the Study:

• To characterize ketorolac administration patterns in emergency department (ED) patients.
• To determine if emergency physicians adhere to the proposed 10 mg analgesic ceiling dose of ketorolac.
• To analyze dosing variations based on administration route (IV, IM, oral).

Main Methods:

• A single-center, retrospective, descriptive study was conducted.
• Data were collected from electronic medical records over a ten-year period (January 1, 2003 - January 1, 2013).
• Analysis included 49,605 ketorolac administrations in an urban community ED.

Main Results:

• The majority of ketorolac administrations were intravenous (78%) and intramuscular (20%).
• Intravenous doses frequently exceeded the ceiling: 84.6% were 30 mg and 0.03% were 60 mg.
• Intramuscular doses also commonly exceeded the ceiling: 49.6% were 30 mg and 45.9% were 60 mg.
• Common diagnoses included renal colic (21%), low back pain (17%), and abdominal pain (11%).

Conclusions:

• Ketorolac was prescribed above the 10 mg ceiling dose in 97% of intravenous administrations.
• Similarly, 96% of intramuscular ketorolac doses exceeded the 10 mg ceiling.
• These findings indicate a prevalent pattern of exceeding the suggested analgesic ceiling dose for ketorolac in the ED.