Ketorolac as an Analgesic in Pediatric Acute Pain Management: A Systematic Review and Meta-analysis

Acute pain is a common complaint in the pediatric emergency department. Ketorolac, a nonsteroidal anti-inflammatory drug, is approved for use in adults but remains underinvestigated in pediatric patients. This meta-analysis aims to evaluate the efficacy and safety of Ketorolac for acute pain management in children.

A systematic search was conducted using electronic databases, including PubMed, Web of Science, Scopus, and CENTRAL. Studies investigating the use of Ketorolac for acute pain in children were included. We followed the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0).

Twenty-four studies were included in this systematic review. The mean change in pain scores with Ketorolac was -2.06 (95% CI: -5.01 to 0.88, P <0.01). The pooled rate of pain freedom at discharge in 103 patients across 3 studies was 66.06% (95% CI: 49.64-82.47, P =0.02). The pooled rate of discharge from the emergency department in 130 patients across three studies was 85.34% (95% CI: 58.83-100, P <0.01). The pooled rate of gastrointestinal adverse events in 267 patients across four studies was 1.53% (95% CI: 0.00-3.39, P =0.07).

Ketorolac appears to be a safe and effective option for managing acute pain in the pediatric population. The results indicate significant pain reduction and a relatively low risk of adverse events. However, randomized controlled trials are necessary to validate these findings and establish appropriate dosing regimens.