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.

The provision of multimodal analgesia is a core concept in the management of acute and chronic pain. In the prehospital setting, non-steroidal anti-inflammatory drugs (NSAIDs) can be used alongside paracetamol and opioids to provide such analgesia. Ketorolac is an NSAID which can be administered by injection and is used internationally in civilian and military prehospital care. This CPD article discusses Ketorolac as an analgesic option for paramedics.

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