Ketorolac versus acetaminophen-codeine in the emergency department treatment of acute low back pain

Innes, Grant; Croskerry, Pat; Worthington, James; Beveridge, Robert; Jones, D. Gwynne

doi:10.1016/s0736-4679(98)00044-4

Cited by 72 publications

(71 citation statements)

References 12 publications

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“…Th ree articles compared fentanyl and morphine (PICO #1); fi ve articles assessed hydromorphone (PICO #2), two of which analyzed the 1 + 1 hydromorphone protocol (PICO #3); three articles compared oral hydromorphone and oxycodone (PICO #4); eight articles compared non-specifi c NSAIDs and co deine-acetaminophen (PICO #5); two articles compared specifi c NSAIDs and co deine-acetaminophen (PICO #6); and fi ve articles compared oxycodone and codeine (PICO #7). Th e same reviewer assessed the full text articles and determined that 14 of the 26 off ered quantitative results that could be analyzed using the GRADE-pro software [28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Th e remaining 12 articles were excluded because they did not compare both drugs assessed in a PICO question [42][43][44][45][46][47], compared analgesics not addressed in the seven P ICO qu estions (such as acetaminophen alone) [48,49], used unconventional medication dosing [50,51], used non-validated pain me asurement scales [52,53], and/or unusual study designs [50].…”

Section: Resultsmentioning

confidence: 99%

“…However, although the number of studies used to make our recommendations may seem low, our re commendations take into consideration the quality of evidence of the studies. Pragmatic derivations of the seven PICO questions, their recommendations, and the rationale for these recommendations are listed in Table 4 [28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Furthermore, we also developed a fl owchart as a suggested approach to analges ia in the ED (Fig.…”

Section: Discussionmentioning

confidence: 99%

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Analgesia in the Emergency Department: A GRADE-based Evaluation of Research Evidence and Recommendations for Practice

Lipp

Dhaliwal

Lang

2013

Annual Update in Intensive Care and Emergency Medicine 2013

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Emergency physicians care for patients with pain on an extremely frequent basis [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Th e prevalence of pain as the presenting complaint of patients seeking eme rgen cy department (ED) care ranges from 38 % [3] to as high as 78 % [1]. As a result, evidence-based use of analgesics should be a foundational skill of emergency physicians. However, the literature consistently reports that emergency physicians are ofte n poor at treating pain [1,2,8,13,14,16,19,20] . Notwithstanding the prevalence of pain in the ED, many patients often report that their pain was no t pr oper ly t reated [3,7,20]. I n addi tion to a compromised patient experience, sub-optimal treatment of pain will result in decreased department fl ow, increased wait times, more return visits to the ED, and increased hospitalization rates.Very few evidence-based resources and guideli nes exis t to inform emergency physicians on how to treat pain. One recent guideline on acute pain management compiled by the college of Anaesthetists of Australia and New Zealand [21] was focused primarily on treating pain perioperatively and did not include stratifi ed or graded recommendations based on the literature, highlighting the paucity of emergency medicine-specifi c guidance. Emergency physicia ns need an eff ective, evidenced-based approach to analyze and apply the options available for acute pain management.Th e objective of this article is to synthesize and evaluate the quality of medical literature surrounding analgesia delivery in the adult ED using the Grading Assessment, Development and Evaluation (GRADE) framework. We further strived to provide emergency physicians with graded recommendations upon which analgesics should be used to treat adults with acute pain in the ED. Question formulationPrior to searching the literature we developed seven clinically-oriented questions based on a scoping of the literature and a review of locally utilized ED analgesic order sets. Th is initial surveying of medical literature and our local practice environment allowed us to identify the most commonly prescribed intravenous and oral analgesics used in adult EDs in our health care region.We then used the patient-intervention-comparisonoutcome (PICO) approach to develop our seven research questions (Table 1). Th is approach has been adopted by many authors of systematic reviews and guideline panels, including the Internati onal Liaison Committee on Resuscitation (ILCOR) and the American College of Chest Physicians (ACCP) [22][23][24]. It involves identifying a specifi c population or setting to which recommen dations may be applied. Subseq uently each question compares two specifi c management strategies (intervention and comparison). Fi nally, we defi ned important patient oriented outcomes (e. g., change in pain) as well as any adverse eff ects of the medication or other safety concerns.All seven draft questions were reviewed and revised through an iterative process involving all authors. Th ese seven cl...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Analgesia in the Emergency Department: A GRADE-based Evaluation of Research Evidence and Recommendations for Practice

Lipp

Dhaliwal

Lang

2013

Annual Update in Intensive Care and Emergency Medicine 2013

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“…Также не выявлено существенной разницы в эффективности перорального кеторолака (по 10 мг каждые 4-6 ч в течение 4 сут) и комбинированного препара-та на основе кодеина и парацетамола у пациентов с болью в нижней части спины в исследовании G.D. Innes и соавт. [11] (n=123). В то же время число нежелательных эффектов у па-циентов, получавших кеторолак, оказалось достоверно мень-ше.…”

Section: ае каратеевunclassified

Ketorolac in clinical practice

Karateev

2011

Neurology, Neuropsychiatry, Psychosomatics

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В XX в. терапия наиболее распространенных заболева-ний и патологических состояний предполагает непростой выбор среди широкого спектра лекарств с близким или оди-наковым механизмом действия и сходными фармакологи-ческими свойствами. С одной стороны, такое разнообразие открывает широкие возможности для индивидуального подбора препаратов в конкретной клинической ситуации с учетом их эффективности, безопасности и, что немаловаж-но, стоимости. С другой стороны, требуется четкое понима-ние достоинств и недостатков современных лекарств. При этом не нужно ориентироваться только на заявленные фир-мой-производителем свойства препарата и данные предре-гистрационных исследований, а с должной мерой скепсиса анализировать весь пласт клинических испытаний и ретро-спективных работ, в которых оцениваются его сравнитель-ная эффективность и безопасность.Это положение в значительной степени касается ра-циональной терапии острой и хронической боли -пробле-мы, представляющей большой интерес для врачей самых разных специальностей. Наиболее популярным классом анальгетиков являются нестероидные противовоспали-тельные препараты (НПВП) [1,2]. В России на 2011 г. было зарегистрировано 18 препаратов (речь идет о непатенто-ванных международных наименованиях) этой лекарствен-ной группы. Все НПВП, хотя и весьма разнородные по хими-ческой природе, объединяет единый механизм действия -способность блокировать фермент циклооксигеназу (ЦОГ) 2 и подавлять синтез простагландинов, важнейших стимуля-торов ноцицептивной системы. Однако фармакологиче-ские свойства этих лекарств различны, что определяет осо-бенности их клинического применения [1][2][3][4][5].В то же время имеются НПВП, которые были созданы практически исключительно для кратковременного лечения выраженной острой боли. Они обладают максимально высо-кой биодоступностью и коротким периодом выведения, а также приспособлены для парентерального введения [2].Ярким представителем «ургентных» НПВП является ке-торолак. Интерес к этому препарату во многом определяется тем, что он впервые был опробован в качестве парентерально-го анальгетика в США -стране, которая, с одной стороны, является «законодателем мод» в анальгетической терапии, а с другой -имеет сложную многоступенчатую систему провер-ки клинических достоинств и безопасности лекарственных средств. В США кеторолак зарегистрирован в 1989 г.

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“…About 2 decades before, it was thought that although ketorolac has a considerable analgesic effect, but has restriction for application as a fast pain abortive in the ED (13). Some other believed that this drug could be considered as a useful adjuvant, or alternative for opioids in subjects with moderate to severe pain (14,15). Thinking that different types of headaches involve the same inflammatory component in their pathophysiology, ketorolac is expected to be effective.…”

Section: Introductionmentioning

confidence: 99%

Efficacy measurement of ketorolac in reducing the severity of headache

Baratloo

Amiri

Mehdi

et al. 2015

Journal of Emergency Practice and Trauma

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Objective: One of nonsteroidal anti-inflammatory drugs (NSAIDs) named as ketorolac is frequently used to relieve acute pain. Current study was conducted with the aim of ketorolac efficacy measurement as a pain killer agent for controlling the primary headache in emergency departments. Methods: In this study, we enrolled 50 patients with primary headache who received 60 mg ketorolac intravenously as a slow infusion in about 10 minutes. Pain scores were evaluated with visual analog scale (VAS) on arrival and also 1 hour and 2 hours after ketorolac infusion. Statistical analysis was performed on collected data by using Wilcoxon and Mann-Whitney tests to assess the differences in VAS pain scores. Results: Decreasing the VAS more than 3 points from the arrival until 1 hour (P < 0.001), and more than 5 points from the arrival until 2 hours after ketorolac administration (P < 0.001) were seen. Those with history of analgesic use before admission in emergency department in comparison with the others did not accompany with more decline in pain score after 1 hour (P = 0.34) or 2 hours (P = 0.92). Conclusion: It seems that ketorolac is assured, safe and well tolerated agent for pain control in patients presented with primary headache to the emergency departments. Based on the results achieved in this study, ketorolac illustrates its perceptible effects within 1 hour after administration that even more prominent after 2 hours.

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Ketorolac versus acetaminophen-codeine in the emergency department treatment of acute low back pain

Cited by 72 publications

References 12 publications

Analgesia in the Emergency Department: A GRADE-based Evaluation of Research Evidence and Recommendations for Practice

Analgesia in the Emergency Department: A GRADE-based Evaluation of Research Evidence and Recommendations for Practice

Ketorolac in clinical practice

Efficacy measurement of ketorolac in reducing the severity of headache

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