Objective
Acute painful conditions are a common reason for emergency department (ED) referral, and a broad variety of analgesic drugs can be used. Among them, ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that has been increasingly used in the past two decades. To clarify the evidence for using ketorolac in EDs, a systematic review and meta-analysis was performed. Methods A search was performed in PubMed for English-language articles published on or before February 2023. Only randomized controlled trials in adult patients with acute painful conditions treated in an ED were selected. A meta-analysis was performed to evaluate the effectiveness of ketorolac in different pain conditions. Results Forty randomized controlled trials were selected, including studies focused on acute renal colic, headache, traumatic and nontraumatic musculoskeletal pain, and biliary colic. In these studies, ketorolac was mainly compared to opioids and showed a similar analgesic efficacy. On the other hand, ketorolac does not seem to have a stronger analgesic effect than other NSAIDs. Conclusion This systematic review indicates that ketorolac may be a valuable alternative to opioids for inducing analgesia in adult ED patients. This meta-analysis showed no significant difference in efficacy between ketorolac and other drugs. Nevertheless, the evidence comparing its efficacy with other common NSAIDs is sparse and should be further explored in future studies.