Ketorolac Dosage for an 11-Year-Old
For an 11-year-old child, administer ketorolac 0.5 mg/kg intravenously or intramuscularly every 6 hours, with a maximum daily dose of 90 mg and treatment duration not exceeding 5 days. 1
Recommended Dosing Regimen
- Initial dose: 0.5 mg/kg IV or IM 1
- Maintenance dosing: Either bolus injections of 0.5 mg/kg every 6 hours OR continuous IV infusion of 0.17 mg/kg/hour 1
- Maximum daily dose: 90 mg 1
- Maximum treatment duration: 48 hours for parenteral administration, though some guidelines allow up to 5 days 1, 2
The intravenous route is strongly preferred over intramuscular injections in children, as IM injections should only be used when IV access is unavailable 1. Once the child can tolerate oral medication, transition to oral ketorolac at 0.25 mg/kg (maximum 1.0 mg/kg/day) for up to 7 days 1.
Critical Safety Considerations
Absolute contraindications that must be screened before administration include 3, 2:
- History of aspirin or NSAID-induced asthma
- Active peptic ulcer disease or gastrointestinal bleeding
- Cerebrovascular hemorrhage
- Compromised renal function
- Pregnancy (not applicable for an 11-year-old, but important for adolescents)
Monitoring Requirements
Before initiating ketorolac therapy, obtain baseline values for 3, 2:
- Blood pressure
- BUN and creatinine (renal function)
- Liver function tests (alkaline phosphatase, LDH, SGOT, SGPT)
- Complete blood count
- Fecal occult blood
For treatment extending beyond 48 hours, repeat these laboratory studies to monitor for toxicity 3.
Clinical Efficacy and Advantages
Ketorolac provides analgesia comparable to morphine in pediatric patients but with significant advantages 1:
- No respiratory depression
- Reduced nausea and vomiting compared to opioids
- No urinary retention
- No sedation
- Marked opioid-sparing effects when used in combination therapy
When combined with opioids, ketorolac allows for lower opioid dosing while maintaining or improving pain control, thereby reducing opioid-related adverse effects 1.
Important Caveats
Bleeding risk: While ketorolac reversibly inhibits platelet function and may slightly increase bleeding time, most values remain within normal limits 1. However, there is conflicting evidence regarding increased bleeding after tonsillectomy specifically 1. For other pediatric surgical procedures, numerous studies confirm ketorolac is not associated with increased bleeding 1.
Age-related pharmacokinetics: Children have a 2-fold higher volume of distribution and increased plasma clearance compared to adults, which is why they require higher weight-based dosing 1, 4. However, the elimination half-life remains similar between children and adults (approximately 236 minutes in infants) 4.
Duration limitations: The risk of serious adverse events—particularly gastrointestinal bleeding, renal impairment, and operative site bleeding—increases significantly with high doses and prolonged therapy beyond 5 days 5. Strict adherence to the 5-day maximum is essential 3, 2, 5.
Quality of evidence: While ketorolac is widely used in clinical practice for pediatric postoperative pain, the overall quality of evidence supporting its use is very low due to heterogeneity in study designs, small sample sizes, and incomplete outcome data 6. Nevertheless, extensive clinical experience and observational data support its safety and efficacy when dosing guidelines are followed 1, 7.