Intramuscular Ketorolac Injections in the Athlete

Abstract

Background:Pain control is a factor in the sideline treatment of competitive athletes. Ketorolac injections by team physicians as a pain control measure are seemingly becoming more mainstream, although there have been very little data published on its use.Hypothesis:Intramuscular ketorolac injections are being used regularly by orthopaedic surgeons and primary care sports medicine physicians in their care of athletes.Study Design:Descriptive epidemiology study.Methods:A 19-question survey was generated online for physician members of the American Orthopaedic Society for Sports Medicine, the Arthroscopy Association of North America, and the American Medical Society for Sports Medicine. The survey link was e-mailed, with reminders sent every 1 to 2 weeks, and results were collected from April to June 2011.Results:The survey was e-mailed to 6950 physicians, with 1100 respondents completing it (60% orthopaedic surgeons, 40% nonsurgical sports medicine physicians). Approximately 49% use intramuscular ketorolac in the treatment of athletes, primarily at the collegiate and professional levels; 95.8% reported effective pain control after administration; 2.9% reported bleeding complications; and 1.9% reported kidney complications from its use.Conclusion:Intramuscular ketorolac injections are used by approximately half of all team physicians in their sideline treatment of competitive athletes.

Ultrasound guided intra-articular ketorolac versus corticosteroid injection in osteoarthritis of the hip: a retrospective comparative study

“…Feldman et al reported that parenteral ketorolac, administered for 5 days or less, had the same rate of renal failure (1.1 %) as parenteral opioids [50]. The antiplatelet effect of NSAIDs has been well documented in the literature [49,51]. For gastrointestinal bleeding, Strom et al [52] found a small association between ketorolac and gastrointestinal bleeding (odds ratio, 1.3), especially when the medication was administered for more than 5 days, dosing greater than 105 mg daily, or in patients aged 65 years and older.…”

“…However, when it is used appropriately, the risk of renal failure is no greater than with other pain medications [49]. Feldman et al reported that parenteral ketorolac, administered for 5 days or less, had the same rate of renal failure (1.1 %) as parenteral opioids [50].…”

“…The most severe complications associated with the use of ketorolac are acute renal failure and increased risk of bleeding [49]. However, when it is used appropriately, the risk of renal failure is no greater than with other pain medications [49].…”

International Olympic Committee consensus statement on pain management in elite athletes

“…These have typically included: oral non-steroidal anti-inflammatory drugs (NSAIDs),2 4 6 16 17 injectable NSAIDs,5 other non-opioid analgesics,1 4 8 9 opioid analgesics,1 3 4 7 8 10 18 injectable and transdermal anaesthetics11 and other medications and over-the-counter supplements 1 3 12–15…”

“…It is important that paracetamol be given in sufficient dosing, including a 2 g loading dose and 1 g every 4–6 hours thereafter, as needed 161. Intramuscular ketorolac has been widely used in certain elite sports because of possible greater analgesic efficacy without significant reported side effects,5 although concerns remain162 and prescribing recommendations are narrow 5 163. If the injury develops with an ongoing haematoma, ketorolac and traditional NSAIDs may worsen the bleeding, whereas this is no concern with paracetamol or a COX-2 selective NSAID 164.…”