Ketorolac analgesia in the emergency department in adults: systematic review and meta-analysis

Tessitore, Antimo; Zupin, Luisa; Celsi, Fulvio; Capaci, Valeria; Amaddeo, Alessandro; Barbi, Egidio; Cozzi, Giorgio

doi:.0..

Clin Exp Emerg Med > Accepted Articles

Systematic Review

doi: https://doi.org/10.15441/ceem.25.002 [Accepted]

Ketorolac analgesia in the emergency department in adults: systematic review and meta-analysis

, Alessandro Amaddeo²

, Egidio Barbi^1,2

, Giorgio Cozzi²

¹Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
²Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy

Correspondence Antimo Tessitore Email: antimo.tessitore.at@gmail.com, Luisa Zupin Email: luisa.zupin@burlo.trieste.it

Received: January 2, 2025. Revised: June 24, 2025. Accepted: July 12, 2025. Published online: August 13, 2025.
*The first two authors contributed equally to this study

ABSTRACT

Background and Objective
Acute painful conditions are a common reason to emergency department (ED) referral, and a broad variety of analgesic drugs may be used. Among them, ketorolac is a Non-Steroidal Anti-Inflammatory Drug (NSAID) increasingly used in the last two decades. In order to clarify the available evidence about the use of ketorolac in the ED setting, a systematic review and meta-analysis was performed.
Databases and data treatment
A search was performed in PubMed for English written articles updated to February 2023. Only randomized controlled trials regarding adult patients with acute painful conditions treated in the 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 non-traumatic musculoskeletal pain, and biliary colic. In these studies, ketorolac was mainly compared to opioids and in general showed a similar analgesic efficacy. On the other hand, when compared to other NSAIDs, ketorolac does not seem to have a stronger analgesic effect.
Conclusions
This systematic review indicates that ketorolac is a valuable option, alternative to opioids, to induce analgesia in adult ED patients, as our meta-analysis showed no significant difference in efficacy compared to opioids or other NSAIDs. Nevertheless, the evidence regarding its efficacy compared to other commonly NSAIDs is still limited and should be further explored in future studies.

Keywords: Ketorolac, emergency department, pain