A review of ketorolac as a prehospital analgesic

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) can be used as part of a multimodal approach to managing acute pain. Administering NSAIDs by intramuscular (IM) or intravenous (IV) injection allows them to be used in patients who are nil-by-mouth, who cannot swallow, and to allow a more rapid onset compared to the oral route. Current paramedic practice in the UK does not generally allow for the use of an NSAID given by IM or IV injection for acute pain. While paramedics may administer paracetamol and morphine intravenously, the only option for an NSAID is oral ibuprofen, or rarely oral naproxen or rectal diclofenac. Ketorolac is an NSAID, which can be administered by IV or IM injection. It is an effective analgesic agent when used alone, or in conjunction with other agents as part of a multimodal approach to analgesia. This article reviews the evidence from peer-reviewed papers and current clinical guidelines surrounding the safety and efficacy of ketorolac as an analgesic agent for acute pain, and discusses its potential use in UK paramedic practice.

Bone Morphogenetic Protein-, Antimicrobial Agent-, and Analgesic-Incorporated Nanofibrous Scaffolds for the Therapy of Alveolar Clefts

“…BMP-2 promotes the expression of other BMP genes in the bone cell differentiation process; furthermore, through paracrine signaling with other BMPs, BMP-2 prompts cell differentiation and bone formation during the remodeling process [24]. Ketorolac belongs to the nonsteroidal anti-inflammatory drug (NSAID) class and is an FDAapproved medication used for the management of acute moderate to severe pain [25] and is commonly used for postoperative pain management. Amoxicillin, a moderate-spectrum, bacteriolytic, β-lactam antimicrobial agent in the aminopenicillin family, is used to cure susceptible Gram-positive and Gram-negative bacteria [26] and has been used to treat bacterial infections, including tonsillitis, bronchitis, pneumonia, and infections of the ear, nose, throat, skin, and urinary tract.…”

Access to Fused Pyrroles from Cyclic 1,3-Dienyl Boronic Esters and Arylnitroso Compounds

“…This includes, in particular, 1 which acts as an inhibitor of the HSP90 protein for regulation of the dopaminergic pathway in Parkinson's disease, 5 2 which blocks CFTR protein for the treatment of severe diarrhea, 6 3 for the prevention of cellular replication of hepatitis C virus (HCV), 7 and 4, an inhibitor of histone deacetylases that play an important role in the regulation of gene expression. 8 Also, ketorolac 5 is a nonsteroidal anti-inflammatory drug with analgesic activity 9 and molindone 6 (Moban) has been used in the United States as an antipsychotic for the treatment of schizophrenia. 10 The synthesis of differently substituted pyrroles has been the subject of a great deal of work and there are numerous reviews describing various strategies.…”

Optimization of structures, biochemical properties of ketorolac and its degradation products based on computational studies

“…Ketorolac (KTR) is one of the most popularly used analgesic drugs all over the world. It is non-steroidal anti-inflammatory drug (NSAID) and member of heterocyclic acetic acid derivatives [1].KTR shows analgesic, anti-inflammation, and antipyretic activities [2]. It is safe and effective analgesic agent for the short-term management of moderate to severe pain and can be used as an alternative to opioid therapy [3].…”