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Evaluation of ketorolac ceiling dose effects in pediatric patients in the emergency department

Isabelle Bindseil1, Rhynn Soderstrom1, Ryan Balmat1

  • 1Department of Pharmacy, Children's Hospital Colorado, Aurora, CO, United States of America.

The American Journal of Emergency Medicine
|December 27, 2024
PubMed

Insights

A 15 mg dose of intravenous ketorolac provided similar pain relief as higher doses in pediatric emergency department patients. This finding suggests a potentially safer dosing strategy for pediatric pain management with ketorolac.

Area of Science:

  • Pediatric Emergency Medicine
  • Pharmacology
  • Pain Management

Background:

  • Ketorolac is frequently used for analgesia in pediatric emergency departments.
  • Optimal dosing guidelines for pediatric ketorolac are lacking, increasing the risk of adverse effects.
  • Standard pediatric dosing often involves a weight-based approach capped at 30 mg, exceeding typical adult maximums.

Purpose of the Study:

  • To compare the analgesic efficacy of a 15 mg dose of intravenous ketorolac against higher doses in pediatric patients.
  • To evaluate the impact of ketorolac dosing on pain score reduction in an emergency department setting.

Main Methods:

  • A retrospective observational study was conducted at a pediatric tertiary academic medical center.
  • Data from July 2021 to July 2022 identified pediatric patients receiving monotherapy intravenous ketorolac (≥15 mg) for acute pain.
  • The primary outcome measured was the change in pain score comparing patients who received 15 mg versus >15 mg of ketorolac.

Main Results:

  • The study included 599 pediatric patients with comparable baseline demographics between groups.
  • No statistically significant difference was observed in pain score reduction between the 15 mg and >15 mg ketorolac dose groups (p=0.84).

Conclusions:

  • A capped dose of 15 mg of intravenous ketorolac demonstrated comparable analgesic effects to higher doses in pediatric emergency department patients.
  • This suggests that a lower, capped dose may be effective for managing acute pain in this population.
Abstract

Keywords:
AnalgesiaDoseEmergency departmentKetorolac

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