Can ketorolac be administered intramuscularly in the deltoid muscle?

Deltoid Administration of Ketorolac

Yes, ketorolac can be administered intramuscularly in the deltoid muscle, and this is an appropriate injection site for adults and older children. 1, 2

Recommended Injection Technique

Inject in the middle third of the deltoid muscle to avoid major neurovascular structures. 3, 2 The deltoid is the preferred site for IM injections in adults and older children because it provides more rapid absorption compared to other sites. 2

Key Technical Points:

• Use a needle length greater than 1 inch for adults to ensure adequate muscle penetration and avoid subcutaneous deposition. 3, 2
• Avoid the upper or lower portions of the deltoid where neurovascular structures are at higher risk of injury. 3, 2
• The arm (deltoid) permits easy access for administration, though the anterolateral thigh (vastus lateralis) produces higher and more rapid peak plasma levels. 1

Dosing for Deltoid Administration

For acute pain management, administer 30 mg IM ketorolac in the deltoid, given 30 minutes to 1-2 hours before a procedure or for acute pain control. 1, 4 The American Academy of Family Physicians recommends that intramuscular ketorolac (60 mg) can be administered every 15-30 minutes with a maximum daily dosage of 120 mg, and treatment should not exceed 5 days. 4

Standard Adult Dosing:

• Loading dose: 30-60 mg IM 5, 6
• Maintenance: 15-30 mg IM every 6 hours 5
• Maximum first-day dose: 150 mg; subsequent days: 120 mg 5
• Maximum duration: 5 days 4, 5

Volume Considerations

The maximum recommended volume for deltoid injection is 0.5 mL in adults. 3 However, ketorolac is typically formulated at concentrations that allow the 30 mg dose to be delivered within this volume limit, making deltoid administration feasible.

Critical Safety Point:

Larger volumes risk inadequate muscle penetration, subcutaneous deposition, local pain, reduced absorption, and increased adverse reactions. 3 For volumes exceeding 0.5 mL, consider the anterolateral thigh (vastus lateralis), which accommodates larger volumes. 3

Clinical Context

Ketorolac provides opioid-level analgesia without respiratory depression, sedation, euphoria, or dependence issues. 4 It is effective for various acute pain conditions including renal colic, migraine headache, musculoskeletal pain, and postoperative pain. 4

Advantages of IM Ketorolac:

• Comparable analgesic efficacy to morphine and meperidine for moderate to severe pain 7, 6
• Reduces opioid requirements by 25-50% when used in combination 4
• No risk of addiction or withdrawal syndrome 4
• Peak plasma levels reached in 45-50 minutes with IM administration 5

Common Pitfalls to Avoid

• Do not use the anterolateral thigh routinely for adult administration—this site is reserved for infants and young children, though it may be considered for volumes exceeding 0.5 mL. 3, 2
• Intramuscular injections are not recommended in children unless the intravenous route is unavailable. 7
• Use lower dose ranges (15-30 mg) for elderly patients, patients weighing less than 50 kg, and patients with impaired kidney function. 5
• The risk of acute kidney injury is particularly high in patients with marginal kidney function. 4