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Ketorolac for Renal Colic – 10, 20, or 30mg IV?

February 5, 2021

Written by Clay Smith

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For acute pain from renal colic in the ED, a dose of ketoroloc as low as 10mg IV was as effective as a 30mg dose.

Why does this matter?
Ketorolac appears to have a ceiling effect with regard to analgesia, and doses above that ceiling don’t provide additive benefit and may increase adverse effects. A prior study for mixed acute pain (abdominal, flank, and musculoskeletal) found no difference between 10mg, 15mg, or 30mg IV.

More ≠ Better
This was a non-inferiority double-blinded, randomized controlled trial comparing three doses of IV ketorolac (10, 20, or 30mg) for patients with renal colic. Each group had 55 patients. There was a drop in visual analog scale pain score in the 30mg group from 90mm to 40mm; a similar 40mm decrease in the 20mg group; and an identical 50mm decrease in the 10mg group. In other words, there was no difference between high and low doses. Need for rescue medication and minor adverse events were the same among the groups.

Comparison of Intravenous Ketorolac at Three Doses for Treating Renal Colic in the Emergency Department: A Non-Inferiority Randomized Controlled Trial. Acad Emerg Med. 2020 Dec 28. doi: 10.1111/acem.14202. Online ahead of print.

What are your thoughts?