From the Guidelines
Intravenous non-narcotic pain medication options, such as IV acetaminophen, IV NSAIDs like ketorolac, and IV ketamine, are recommended for pain management to avoid opioid-related side effects. These alternatives can provide effective pain relief, particularly when used in multimodal pain management approaches. According to the most recent and highest quality study available 1, IV acetaminophen is recommended as a baseline treatment for all pain intensities because it decreases supplementary analgesic requirements.
Non-Opioid Analgesia Options
- IV acetaminophen (Ofirmev), typically dosed at 1000mg every 6 hours with a maximum daily dose of 4000mg
- IV NSAIDs such as ketorolac (Toradol), given as 15-30mg every 6 hours for a maximum of 5 days
- IV ketamine at sub-anesthetic doses of 0.1-0.5 mg/kg for acute pain
- IV lidocaine infusions at 1-2 mg/kg/hr for certain pain types, particularly neuropathic pain
- Dexmedetomidine (Precedex) at 0.2-0.7 mcg/kg/hr
- Metoclopramide at 10mg every 6 hours, which can help with pain associated with migraines or nausea
These medications work through different mechanisms than opioids, such as affecting central prostaglandin synthesis, inhibiting cyclooxygenase enzymes, blocking NMDA receptors, stabilizing neuronal membranes, and acting on alpha-2 adrenergic receptors. Using these alternatives can help avoid opioid-related side effects like respiratory depression, constipation, and dependence while still providing effective pain relief. As noted in the study 1, nonopioids such as IV acetaminophen, oral, IV, or rectal cyclooxygenase inhibitors, or IV ketamine can be used in addition to opioids to decrease the overall quantity of opioids administered and the incidence and severity of opioid-related side effects.
From the FDA Drug Label
Ketorolac tromethamine, a nonsteroidal anti-inflammatory drug (NSAID), is indicated for the short-term (up to 5 days in adults) management of moderately severe acute pain that requires analgesia at the opioid level.
Acetaminophen is used for the treatment of acute pain and fever.
Alternative IV pain medication options besides intravenous (IV) opioids (narcotics) include:
- Ketorolac (IV): a nonsteroidal anti-inflammatory drug (NSAID) for short-term management of moderately severe acute pain
- Acetaminophen (IV): for the treatment of acute pain and fever
From the Research
Alternative IV Pain Medication Options
Besides intravenous (IV) opioids, there are several alternative IV pain medication options available. These include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac 4
- Acetaminophen 5, 6
- Neuromodulatory agents such as gabapentin 6
- Corticosteroids 6
- Centrally acting α2 agonists 6
- Ketamine 6
Mechanism of Action
These alternative options work through different mechanisms to provide pain relief. For example:
- NSAIDs, such as ketorolac, work by inhibiting the production of prostaglandins, which are chemicals that cause pain and inflammation 4
- Acetaminophen works by inhibiting the production of prostaglandins in the brain, which helps to reduce pain and fever 5, 6
- Gabapentin and other neuromodulatory agents work by modifying the way that nerves transmit pain signals 6
Efficacy and Safety
The efficacy and safety of these alternative options have been studied in various clinical trials. For example:
- A study found that IV ketorolac reduced the need for meperidine by approximately 30% after cesarean delivery 4
- A review of the literature found that combination therapy with opioids and non-opioids can improve pain management and reduce the risk of adverse effects 7
- A study found that non-opioid analgesics, including local anesthetics, NSAIDs, and acetaminophen, can be effective for postoperative pain management 6