Injectable Ketorolac (Toradol) for Post-Operative Pain Management: Duration and Dosing Schedule
For post-operative pain control in a patient who cannot tolerate oral NSAIDs, injectable ketorolac (Toradol) should be limited to a maximum duration of 5 days, with dosing of 30 mg every 6 hours (or 15 mg every 6 hours for patients ≥65 years, renally impaired, or <50 kg). 1
Recommended Dosing Schedule
Initial Dose
- For patients <65 years: 60 mg IM as a single loading dose 1, 2
- For patients ≥65 years, renally impaired, or <50 kg: 30 mg IM as a single loading dose 1
Maintenance Dosing
- For patients <65 years: 30 mg IM/IV every 6 hours 1
- For patients ≥65 years, renally impaired, or <50 kg: 15 mg IM/IV every 6 hours 1
Maximum Limits
- Maximum daily dose for patients <65 years: 120 mg 1, 2
- Maximum daily dose for patients ≥65 years, renally impaired, or <50 kg: 60 mg 1
- Maximum duration of treatment: 5 days (absolute limit) 1, 2
Administration Guidelines
- Intramuscular injections should be given slowly and deeply into the muscle 1
- Intravenous bolus must be administered over no less than 15 seconds 1
- Onset of analgesic effect begins in approximately 30 minutes 1
- Maximum effect is achieved in 1-2 hours after dosing 1, 3
- Duration of analgesic effect is typically 4-6 hours 1
Important Considerations
Efficacy
- Ketorolac provides substantial pain relief for most post-operative patients 4
- It can be used as a standalone analgesic or as an adjunct to reduce opioid requirements 3, 4
- When combined with opioids, ketorolac exhibits marked opioid-sparing effects 5
Safety Precautions
- Correct hypovolemia prior to administration 1
- Switch to alternative analgesics as soon as possible 1
- For breakthrough pain, do not increase the dose or frequency of ketorolac 1
- Consider supplementing with low doses of opioids "prn" unless contraindicated 1
Contraindications
- Avoid in patients with aspirin/NSAID-induced asthma 2
- Avoid in pregnant patients 2
- Avoid in patients with cerebrovascular hemorrhage 2
- Do not use with curative doses of anticoagulants 6
Common Side Effects
- Edema, drowsiness, dizziness 2
- Gastrointestinal upset 2, 7
- Increased diaphoresis (sweating) 2
- Slightly increased risk of adverse events compared to placebo and other NSAIDs 4
Transition Plan
- Patients should be transitioned to alternative analgesics as soon as clinically appropriate 1
- When oral medication becomes tolerable, consider other analgesic options since the patient cannot tolerate oral NSAIDs 1
- Consider multimodal analgesia approaches including paracetamol (acetaminophen) and, if appropriate, weak opioids 6
Remember that ketorolac is intended for short-term management of moderately severe, acute pain that requires analgesia at the opioid level, and not for long-term pain management 1.