Uses for Toradol (Ketorolac) IM
Toradol (ketorolac) IM is primarily indicated for the short-term management (≤5 days) of moderately severe acute pain that requires opioid-level analgesia, particularly in postoperative settings. 1
Primary Indications
- Moderately severe acute postoperative pain requiring opioid-level analgesia 1
- Renal colic, migraine headache, and musculoskeletal pain 2
- Acute pain management as an alternative to opioids in emergency settings 2
- Management of post-surgical pain in various specialties including orthopedics, general surgery, and anorectal procedures 3, 4
Dosing Guidelines
- For patients <65 years: 60 mg IM as single dose or 30 mg IM every 6 hours for multiple dosing 1
- For patients ≥65 years, renally impaired, or <50 kg: 30 mg IM as single dose or 15 mg IM every 6 hours for multiple dosing 1
- Maximum daily dose: 120 mg for patients <65 years; 60 mg for elderly, renally impaired, or lightweight patients 1
- Treatment duration must not exceed 5 days 1
Mechanism and Onset
- Ketorolac is an NSAID with analgesic, anti-inflammatory, and antipyretic properties 5
- Unlike opioids, it does not bind to opioid receptors and works peripherally 5
- Onset of analgesic effect begins in approximately 30 minutes with peak effect in 1-2 hours 1
- Duration of analgesic effect typically lasts 4-6 hours 1
Clinical Advantages
- Provides opioid-level analgesia without respiratory depression, sedation, or dependence issues associated with opioids 5
- Can be used as part of multimodal analgesia to reduce overall opioid requirements 6
- Studies show comparable efficacy to morphine and meperidine for moderate to severe pain 4, 7
- May reduce postoperative nausea, vomiting, and sedation compared to opioid-based regimens 6
Contraindications and Precautions
- Avoid in patients with aspirin/NSAID-induced asthma 8
- Contraindicated during pregnancy 8
- Avoid in patients with cerebrovascular hemorrhage 8
- Use with caution in patients with renal impairment 1
- Hypovolemia should be corrected prior to administration 1
- Not recommended for use with curative doses of anticoagulants 8
Adverse Effects
- Common side effects include edema, drowsiness, dizziness, GI upset, and increased sweating 8
- Risk of acute kidney injury, particularly in patients with marginal kidney function 6
- Potential for GI bleeding and other NSAID-associated complications 7
Special Populations
- Pediatric use: Can be used in children at doses of 0.5-1 mg/kg, particularly effective in reducing postoperative opioid requirements 8, 6
- Elderly patients require dose reduction (30 mg IM single dose or 15 mg IM every 6 hours) 1
Clinical Pearls
- For breakthrough pain, do not increase the dose or frequency of ketorolac; consider supplementing with low doses of opioids "prn" unless contraindicated 1
- Consider transitioning to oral analgesics as soon as possible 1
- When administering IM, inject slowly and deeply into the muscle 1
- In some surgical settings (e.g., anorectal surgery), direct injection into the surgical site has shown effectiveness 3
Ketorolac should be used as part of a comprehensive pain management strategy, with patients being switched to alternative analgesics as soon as possible to minimize the risk of adverse effects associated with prolonged NSAID use 1.