Severe pain can disrupt your daily routine and significantly affect your quality of life. Many people live in discomfort, with data showing that 24.3% of adults in the United States report daily pain.
Ketorolac tromethamine is a widely used medication that can treat pain without opioids. This article unpacks ketorolac tromethamine injection's medical, practical, and emotional facets, empowering patients and professionals to make an informed medication choice.
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Understanding Ketorolac Tromethamine Injection
Ketorolac tromethamine (Toradol) is an FDA-approved nonsteroidal anti-inflammatory drug (NSAID) indicated for the short-term management of moderate to severe acute pain. It is available in injection, nasal spray, oral, and intravenous forms.
Mechanism of Action
The exact mechanism of action for ketorolac is not known. It works in part by inhibiting cyclooxygenase (COX-1 and COX-2), which are enzymes involved in producing prostaglandins that mediate pain, inflammation, and fever.
Some studies suggest ketorolac may provide more potent pain relief than other NSAIDs, but its effectiveness varies depending on the medical condition and patient response.
Medical Applications
Ketorolac is often prescribed after surgery to reduce pain and is used alone or combined with opioids. The combination of these medications may reduce the amount of opioids necessary to control pain and may reduce post-operative nausea, vomiting, and decreased gastric motility.
Studies suggest the use of ketorolac with other medications for pain showed less opioid use overall and fewer side effects associated with opioid use (e.g., constipation). Ketorolac is often given during joint replacement surgery to help manage pain and reduce opioid use.
Ketorolac can be injected into joints with osteoarthritis to manage pain and increase mobility. It is sometimes combined with a corticosteroid to further reduce inflammation.
In emergency settings, ketorolac may be used to manage pain associated with kidney conditions, migraines, pain from muscle or bone injury, and sickle cell disease.
Additionally, ketorolac may be used to decrease pain associated with cancer.
Dosage Guidelines
Dosing should always be determined by a qualified healthcare provider based on FDA guidelines and patient-specific factors.
Recommended dosing for adults is:
- Intravenous (IV) and intramuscular (IM): 30 mg in one dose or 30 mg every 6 hours. Do not take more than 120 mg in a day.
- Oral: 20 mg dose after an injection (IV or IM), then 10 mg every 4 to 6 hours. Do not take more than 40 mg in a day.
Pediatric dosing guidelines are as follows:
- It is not recommended for children under two years old.
- Ages 2-16:
- Single dose: 0.5 mg/kg IV/IM once; do not give more than 15 mg.
- Multiple doses: 0.5 mg/kg IV/IM every 5 hours; do not give for more than 5 days.
- Older than 16, weighing less than 50 kg:
- IV: 15 mg single dose or 15 mg every 6 hours; do not give more than 60 mg daily.
- IM: 30 mg in a single dose or 15 mg every 6 hours; do not give more than 60 mg daily.
- PO (by mouth): 10 mg once after IV/IM therapy, then 10 mg every 6 hours. Do not give more than 40 mg in a day.
Ketorolac is metabolized by the kidneys, so this medication and other NSAIDs should be avoided when a patient has reduced kidney function.
Administration Methods
An intramuscular injection (IM) is a method of injecting the medication via a syringe into a muscle. Muscles have good blood flow, allowing the medication to circulate throughout the body.
This type of injection is typically given in the upper arm (deltoid), buttocks (dorsogluteal or ventrogluteal), or the side of the thigh (vastus lateralis). A trained professional gives an intramuscular injection.
An intravenous injection (IV) is a common route of medication administration. The drug is injected into a vein, allowing for quick absorption by the body while optimizing drug metabolism. A trained professional should perform intravenous injections.
Benefits and Risks
It is crucial to understand the benefits and risks of this drug.
Advantages of Ketorolac Tromethamine
There are several advantages of ketorolac, including pain relief and inflammation reduction without the risk of dependency.
It can help reduce the need for opioids for pain management, especially during the post-operative period. Less opioid use can minimize side effects and risk of medication dependence.
An additional advantage of ketorolac is its relatively low cost. In a trial comparing intravenous morphine and ketorolac for pain relief, patients had similar pain reduction with both medications, but ketorolac was less expensive.
Side Effects and Contraindications
Possible side effects of ketorolac include:
- Swelling of face and extremities (hands and feet)
- Bruising
- Increased blood pressure
- Skin rash
- Sores in the mouth
Ketorolac has many medication interactions. Talk with your medical provider before starting this drug.
This medication should be used cautiously with a history of:
- Alcohol abuse
- Diabetes
- Edema (swelling)
- Kidney impairment
- Liver disease
- Asthma
- Heart disease
- High blood pressure
- Lupus
Always consult your healthcare provider before implementing a new medication, especially if you have a chronic condition.
Ketorolac is not recommended in pregnancy, labor and delivery, or for women planning to conceive.
Ketorolac is contraindicated in the third trimester of pregnancy. Its use earlier in pregnancy requires a risk versus benefit analysis by a healthcare provider.
Caution should be used in breastfeeding. Consult your provider before using this medication if you are nursing.
Ketorolac Tromethamine in Practice
Here is an example of how ketorolac may be applied in practice.
Case Study
A 45-year-old patient had surgery to remove their gallbladder due to painful gallstones. The surgery went well, but after waking up, the patient had moderate to severe pain at the surgical site, rating it a 7 out of 10 on the pain scale.
Pain Treatment
To help with pain while minimizing the use of strong pain medications like opioids, the doctor gave the patient ketorolac, a type of nonsteroidal anti-inflammatory drug (NSAID).
- First dose: 30 mg of ketorolac given through an IV in the recovery room.
- Later doses: 10 mg taken by mouth every 6 hours as needed, for no more than 5 days.
Results
After 30 minutes, the patient's pain dropped to 4 out of 10. Over the next 12 hours, with regular doses, their pain stayed between 3 and 5 out of 10. The patient was able to move around and eat normally. No opioids were needed.
Side Effects and Safety
Healthcare providers checked for possible side effects, like stomach pain, kidney problems, or bleeding. The patient had no serious issues, and kidney function stayed normal.
The patient was sent home with instructions to stop taking ketorolac after 5 days and switch to acetaminophen if needed.
Outcome
In this case, ketorolac helped relieve pain after surgery without the use of opioids. The treatment worked well because the patient followed the correct dosage and only used the medicine for a short time.
Individual results may vary. This case is an example and should not replace medical advice. Always consult your provider before starting a new treatment.
Insights for Healthcare Providers
Healthcare providers should identify populations at risk for medication misuse and employ alternative medications (such as ketorolac) when possible.
Caution should be used when prescribing this medication due to drug interactions and possible side effects.
Exploring Alternatives and Complementary Therapies
Non-pharmacologic approaches may be considered alongside standard medical treatments for pain management.
Physical therapy and acupuncture can be utilized to improve musculoskeletal pain and improve mobility.
Mindfulness is an additional option for coping with pain in everyday life.
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Key Takeaways
- Ketorolac tromethamine is an NSAID used to treat moderate to severe pain without opioids.
- It works by blocking substances in the body that cause pain, swelling, and fever.
- Healthcare providers prescribe ketorolac after surgery for joint pain, kidney pain, migraines, and more.
- Depending on the individual and situation, it can be given as an injection, IV, pill, or nasal spray.
- Ketorolac helps reduce opioid use, has fewer side effects than opioids, and is cost-effective.
- Possible side effects include swelling, bruising, high blood pressure, and skin rashes.
- Consult your healthcare provider to determine if ketorolac can be integrated into your pain management treatment plan.
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