Written by Joshua Belfer
Spoon Feed
Ketorolac is a safe and effective non-opioid option for managing acute pain in children, with good analgesic efficacy and low rates of adverse events.
No opioids, no problem
Pediatric acute pain is common, and opioid avoidance is increasingly a clinical priority. This systematic review and meta-analysis pooled data from 24 studies (n=1,569 patients) to evaluate efficacy and safety of ketorolac in children. Ketorolac reduced pain scores by a mean of −2.06 (95%CI −5.01 to −0.88), achieved pain freedom at discharge in 66.1%, and enabled emergency department discharge in 85.3% of cases. Adverse event rates were low: gastrointestinal (1.5%), neurological (1.0%), and respiratory (0.7%). This study was limited by significant heterogeneity in patient populations, dosing strategies, and study designs, with inclusion of both RCTs and observational studies.
How does this change my practice?
We know that opioid prescribing in pediatrics has received a lot of attention, with the AAP recently releasing Clinical Practice Guidelines. For those patients needing a bit more analgesia than they received from oral acetaminophen or ibuprofen, I tend to reach for IV or IM ketorolac. This paper reaffirms the safety profile of ketorolac, making it a great option for managing pain in the ED. We already tend to use it in our migraine cocktails, but there are likely other scenarios in which it is an effective option, like sore throat with decreased oral intake.
Source
Ketorolac as an Analgesic in Pediatric Acute Pain Management: A Systematic Review and Meta-analysis. Pediatr Emerg Care. 2025 May 7. doi: 10.1097/PEC.0000000000003381. Epub ahead of print. PMID: 40326658
