Head to Head: IM Ketorolac vs. Oral Ibuprofen

Ketorolac, the only parenteral nonsteroidal anti-inflammatory drug available in the U.S., has enjoyed much success since its release. But initial studies comparing ketorolac favorably to moderate-strength opioids have been criticized on the basis of design, and no study has convincingly shown its superiority over various oral NSAIDs.

This double-blind study from San Francisco General Hospital randomized a convenience sample of 119 ED patients with moderate-to-severe pain (5 to 8 on a self-rated 10-point scale) to 60 mg of ketorolac IM and oral placebo, or 800 mg of oral ibuprofen and IM placebo (saline). Pain sources varied, but patients with sickle-cell or migraine pain and those in resuscitation rooms were excluded. Pain was scored at base…