A review of ketorolac as a prehospital analgesic

Mallinson, Tom

doi:10.12968/jpar.2019.11.11.cpd1

Cited by 6 publications

(9 citation statements)

References 21 publications

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“…Moreover, the pain-intensity difference, the total pain relief, and the time-weighted sum of anxiety in the first 24 hours were more ameliorated with the ketorolac + tramadol + fentanyl regimen than with the ketorolac + tramadol regimen, suggesting that fentanyl may be a potent analgesic in early management of acute pain under emergency settings 67. Although ketorolac is a first-generation NSAID used for short-term management of moderate-to-severe pain,68 it is obvious that further improvement in pain relief is achieved when used as an adjuvant to opioid medications, as was shown in this study.…”

Section: Introductionmentioning

confidence: 99%

Vaso-occlusive crisis in sickle cell disease: current paradigm on pain management

Uwaezuoke¹,

Ayuk²,

Ndu³

et al. 2018

JPR

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This narrative review aims to highlight the current paradigm on pain management in sickle cell vaso-occlusive crisis. It specifically examines the pathophysiologic mechanisms of sickle cell pain as well as the pharmacologic and nonpharmacologic methods of pain management. Recurrent painful episodes constitute the major morbidity in sickle cell disease (SCD). While adolescents and young adults experience mostly acute episodic nociceptive pain, it is now recognized that a significant number of adult patients develop chronic neuropathic and centralized pain. In fact, current evidence points to an age-dependent increase in the frequency of SCD patients with chronic pain. Management of disease-related pain should be based on its pathophysiologic mechanisms instead of using recommendations from other non-SCD pain syndromes. Pain management in vaso-occlusive crisis is complex and requires multiple interventions such as pharmacologic, nonpharmacologic, and preventive therapeutic interventions. Pharmacologic treatment involves the use of non-opioid and opioid analgesics, and adjuvants – either singly or in combination – depending on the severity of pain. The basic approach is to treat SCD pain symptomatically with escalating doses of non-opioid and opioid analgesics. Given the moderate-to-severe nature of the pain usually experienced in this form of SCD crisis, opioids form the bedrock of pharmacologic treatment. Multimodal analgesia and structured, individualized analgesic regimen appear more effective in achieving better treatment outcomes. Although the current evidence is still limited on the supportive role of cognitive behavioral therapy in pain management, this nonpharmacologic approach is reportedly effective, but needs further exploration as a possible adjunct in analgesia.

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Section: Introductionmentioning

confidence: 99%

Vaso-occlusive crisis in sickle cell disease: current paradigm on pain management

Uwaezuoke¹,

Ayuk²,

Ndu³

et al. 2018

JPR

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“…Amongst the NSAIDs, ketorolac has beneficial effects in patients with exaggerated or severe inflammation and it can be used even as an opioid-sparing analgesic drug [ 7 ]. Parenteral ketorolac has been suggested as an appropriate analgesic in the pre-hospital settings in patients with acute pain [ 8 ]. Patients with irreversible pulpitis have moderate to severe type of odontogenic pain consequent to which the success of IANB may be low.…”

Section: Introductionmentioning

confidence: 99%

Oral Ketorolac with Inferior Alveolar Nerve Block for Irreversible Pulpitis: A Systematic Review and Meta-analysis

Sivaramakrishnan¹,

Sridharan²

2018

TODENTJ

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Background:Ketorolac has advantages over other analgesics as a pre-anaesthetic medication. Considering this in mind, the present meta-analysis aims to identify the effect of oral ketorolac premedication on the anaesthetic efficacy of Inferior Alveolar Nerve Block (IANB) in patients with irreversible pulpitis.Methods:Full-texts of eligible studies were obtained from electronic databases. The extracted data was analysed using non-Cochrane mode in RevMan 5.0 software. Relative risk [95% CI] was calculated for the success of IANB.Results:Four studies were included for the final review. The success rate of IANB on 221 patients with relative risk of 1.87 [1.36, 2.56] was statistically significant favouring ketorolac. The mean difference for VAS in 171 patients was not statistically significant {-13.55 [-33.91, 6.82]}.Conclusion:Oral ketorolac can be successfully administered as a premedication before conventional inferior alveolar nerve block for endodontic treatment for irreversible pulpitis.

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“…The pain of abdominal, nausea, gastrointestinal bleeding, headache, dizziness, and swelling are the common side effect, otherwise serious side effects like stroke, disease of heart, kidney problems, and ulceration of stomach, it is contraindicated in third pregnancy trimester, also idicated through breastfeeding, it is work depend upon decreasing prostaglandin production (1) . It lead to cycloxygenase-1 (COX-1) and cycloxygenase-2 (COX-2) blocks (8) .…”

Section: Diclofenacmentioning

confidence: 99%

“…NSAIDs (Nonsteroidal anti-inflammatory drugs), are a class of medicine that lower fever and reduce pain, prevents blood clots, with high doses lead to decrease inflammation (1) . The prominent members of this drugs group, aspirin; ibuprofen also naproxen, are mostly available in most countries as over the counter (2) .…”

Section: Introductionmentioning

confidence: 99%

Clinical and Histopathological Study of Diclofenac SodiumAcetylsalicylic Acid Toxic Effect on Liver of Mice

Salih¹

2020

Indian Journal of Forensic Medicine & Toxicology

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Both over-the-counter (OTC) and prescription analgesics-antipyretics like ibuprofen which is nonsteroidal anti-inflammatory drugs (NSAIDs) have effective as well as safe use for long time. Reversible inhibition of cyclooxy genase enzymes is the mode of action of NSAIDs over all. Use of NSAID lead to drug adverse reactions such as cardiovascular and gastrointestinal bleeding also effects of renal. Drug-drug interactions (DDIs) within the NSAID and a concomitant medication cause adverse drug reaction to several cases. DDIs have been reported for example, when commonly used medica tions as well as some antihypertensive, alcohol, aspirin, antidepressants are coadministered with NSAIDs. Dependent on total drug exposure cause a continuous risk in that the potential for an ADR due to interactions pharmacologic nature. When assessing ADRs potential risk is important to consideration the use of NSAID dose and duration, also the comedication type or class administered. The sub acute toxicity were carried out on thirty mice divided to three equally groups (10 mice in sub group) which were dosed for two weeks daily as follows: group one (control) was givin distilled water, the group two was get diclofenac (voltaren) (100mg/kg B.W.) and group three was givin diclofenac (voltaren) with aspirin (100mg/kg B.W.) for each together. Clinical signs of toxicity appear as following: abdominal pain, nausea, dizziness, anorexia, ataxia, blueness of the chest area, shortness of breath and Paralysis of the posterior limbs and recumbence, finally the death of mouse. Serum liver enzyme (ALT and AST) were elevated in all groups (diclofenac and diclofenac with aspirin) as compare to control after two weeks. Considering histopathological studies of liver tissue after two weeks of daily treatment, which showed moderated mononuclear cells infiltration in portal area around blood vessels and bile duct for voltaren group and fatty vacuoles in the cytoplasm of hepatic cells, single cells necrosis and severe inflammatory cells infiltration in the capsular area for voltaren with aspirin group. We concluded that diclofenac and diclofenac with aspirin have toxic effect appear by clinical symptoms and damage to liver, furthermore, don't administration of more than one NSAID at same time.

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A review of ketorolac as a prehospital analgesic

Cited by 6 publications

References 21 publications

Vaso-occlusive crisis in sickle cell disease: current paradigm on pain management

Vaso-occlusive crisis in sickle cell disease: current paradigm on pain management

Oral Ketorolac with Inferior Alveolar Nerve Block for Irreversible Pulpitis: A Systematic Review and Meta-analysis

Clinical and Histopathological Study of Diclofenac SodiumAcetylsalicylic Acid Toxic Effect on Liver of Mice

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