Narrative review shows that the short‐term use of ketorolac is safe and effective in the management of moderate‐to‐severe pain in children

Marzuillo, Pierluigi; Calligaris, Lorenzo; Amoroso, Stefano; Barbi, Egidio

doi:10.1111/apa.14189

Cited by 14 publications

(8 citation statements)

References 58 publications

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“…It is still not indicated for paediatric use [ 5 ], except for post-operative pain. However, a growing number of studies suggest good safety and efficacy in children in different settings, particularly for acute musculoskeletal pain [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Oral ibuprofen versus oral ketorolac for children with moderate and severe acute traumatic pain: a randomized comparative study

et al. 2022

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This study is to compare ibuprofen and ketorolac for children with trauma-related acute pain. We conducted a multicentre randomized, double-blind, controlled trial in the Paediatric Emergency Department setting. We enrolled patients aged 8 to 17 who accessed the emergency department for pain related to a limb trauma that occurred in the previous 48 h. At the admission, patients were classified based on numeric rating scale-11 (NRS-11) in moderate (NRS 4–6) and severe (NRS 7–10) pain groups. Each patient was randomized to receive either ibuprofen (10 mg/kg) or ketorolac (0.5 mg/kg) and the placebo of the not given drug in a double dummies design. NRS-11 was asked every 30 min until 2 h after drug and placebo administration. The primary outcome was NRS-11 reduction at 60 min. Among 125 patients with severe pain, NRS-11 reduction after 60 min from drug administration was 2.0 (IQR 1.0–4.0) for ibuprofen and 1.0 (IQR 1.0–3.0) for ketorolac (p = 0.36). Ibuprofen was significantly better, considering secondary outcomes, at 90 min with a lower median of NRS-11 (p 0.008), more patients with NRS-11 less than 4 (p 0.01) and a reduction of pain score of more than 3 NRS-11 points (p 0.01). Among 87 patients with moderate pain, the NRS-11 reduction after 60 min from drug administration was 1.63 (± 1.8) for ibuprofen and 1.8 (± 1.6) for ketorolac, with no statistically significant difference. Conclusions : Oral ibuprofen and ketorolac are similarly effective in children and adolescents with acute traumatic musculoskeletal pain. Trial registration : ClinicalTrial.gov registration number: NCT04133623. What is Known: • Limb trauma is one of the most common causes of paediatric emergency department visits. Non-steroidal anti-inflammatory drugs are the most frequently used analgesics in this clinical setting. In particular ibuprofen is the first over the counter non-steroidal anti-inflammatory drug in terms of use. Ketorolac is considered the most effective non-steroidal anti-inflammatory drug for severe pain. What is New: • This study directly compared oral ibuprofen and ketorolac for moderate and severe acute traumatic pain in children and adolescents. Both drugs were similarly effective in children and adolescents with severe pain, and ketorolac was not superior to Ibuprofen for moderate pain.

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Section: Introductionmentioning

confidence: 99%

Oral ibuprofen versus oral ketorolac for children with moderate and severe acute traumatic pain: a randomized comparative study

et al. 2022

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“…Металлы применяются в медицине на протяжение многих лет, и лекарства на их основе успешно прошли клинические испытания и в настоящее время одобрены министерствами здравоохранения многих стран [2]. Среди НСПВВ наиболее известными являются кеторолак трометамин (кеторолак) [3] и ацетилсалициловая кислота (аспирин) [4]. Несмотря на то, что применение кеторолака не вызывает привыкания, тошноту и побочные эффекты в органах дыхательной системы, данное лекарство, как и ацетилсалициловая кислота, аггрессивно воздействует на желудочно-кишечный тракт при продолжительном применении.…”

Section: Introductionunclassified

Effect of ultrasound on nonsteroidal anti-inflammatory drugs complexed with copper, iron, zinc and graphene oxides

Михновец¹,

Tkach²,

Fedosenko³

et al. 2020

Doklady Belorusskogo gosudarstvennogo universiteta informatiki

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This work aims at the formation of nanocomposites based on graphene and metal oxides (copper-iron, zinc and iron) through ultrasonic interaction (20 kHz) and investigation of their electromagnetic properties by scanning electron microscopy, Raman and absorption spectroscopy, and fluorescence methods. The output of this work implies the development of a single-step ultrasound method to form functional Cu/Fe-, ZnO-and Fe3O4-polyvinyl alcohol nanocomposites, and the ultrasonic conjugation of these nanocomposites with pristine drugs, such as ketorolac and acetylsalicylic acid. We established that formed Cu/Fe-graphene-ketorolac, ZnO-grapheneacetylsalicylic acid and Fe3O4-ketorolac obtain optical and superparamagnetic properties of nanoparticles with improved electromagnetic characteristics due to ultrasonic conjugation. Cu/Fe-graphene-ketorolac nanocomposites are revealed to have a spherical shape (< 100 nm) and acquire improved optoelectronic properties due to copper and iron atoms in the matrix of graphene. It is demonstrated that ZnO-graphene-acetylsalicylic acid nanocomposites obtain properties of fluorescence mainly for electromagnetic interaction with the ZnO phase formed on the surface of graphene. Ultrasonic conjugation of ketorolac with magnetite proved to increase the electron density of Fe3O4-ketorolac that obtains superparamagnetic properties, and its biocompatibility can be improved when coated with polyvinyl alcohol. In general, formed nanocomposites are of great interest in medical electronics and nanomedicine as functional materials with electromagnetic properties being controlled at the molecular and atomic levels. Such nanocomposites can also find application as components in electronic devices for diagnosis and treatment of serious inflammatory disorders. Industries will find the singlestep ultrasound method of special interest because it is eco-friendly and can be scaled up by a versatile spectrum of inorganic and organic materials and drugs.

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“…[1] Among many NSAIDs, ketorolac is related to pyrroles and is the most potent and effectivea nalgesic for use after surgery with an efficacy comparable to that of opioids. [2] The pyrrolizidinec arboxylic acidd erivative of ketorolac is structurally related to indomethacin, whicha cts as a cyclooxygenase-2 (COX-2)i nhibitor.R ecently,k etorolac demonstrated downregulation of the expression of the regulatory subunit of caseink inase 1i nW nt-b-catenin signaling, that is, DDX3, which is involved in the progression of several types of cancer. [3] The anticancer activity of ketorolac can be associated with its free binding energy being closer to that of DDX3 inhibitors, its capability to form strongh ydrogen bonds similar to that of crystallized DDX3 protein, and to inhibit adenosine triphosphate (ATP) hydrolysis to decrease the number of neoplastic lesions.…”

Section: Introductionmentioning

confidence: 99%

“…Nonsteroidal anti‐inflammatory drugs (NSAIDs) are among the most commonly prescribed medications worldwide to treat inflammation and pain, thereby reducing fever and inhibiting thrombocyte aggregation . Among many NSAIDs, ketorolac is related to pyrroles and is the most potent and effective analgesic for use after surgery with an efficacy comparable to that of opioids . The pyrrolizidine carboxylic acid derivative of ketorolac is structurally related to indomethacin, which acts as a cyclooxygenase‐2 (COX‐2) inhibitor.…”

Section: Introductionmentioning

confidence: 99%

Sonochemical Formation of Copper/Iron‐Modified Graphene Oxide Nanocomposites for Ketorolac Delivery

Radziuk

Mikhnavets

Vorokhta

et al. 2019

Chemistry A European J

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Af easible sonochemicala pproach is described for the preparationo fc opper/iron-modified graphene oxide nanocomposites through ultrasonication (20 kHz, 18 Wcm À2 ) of an aqueous solutionc ontaining coppera nd iron ion precursors. Uniquec opper-, copper/iron-and iron-modified graphene oxide nanocomposites have as ubmicron size that is smaller than that of pristine GO and ah ighers urfacea rea enriched with Cu 2 O, CuO, and Fe 2 O 3 of multiform phases (a-, b-, e-, or g), FeO(OH), and sulfur-o rc arbon-containingc om-pounds. These nanocomposites are sonochemically intercalated with the nonsteroidal anti-inflammatory drug ketorolac, which results in the formationo fn anoscale carriers. Ketorolac monotonically disintegratesf rom these nanoscale carriers in aqueous solution upon adjustment of the pH from 1t o8 .T he disintegration of ketorolacp roceeds at a slowerr ate from the copper/iron-modified grapheneo xide at increased pH, but at af aster rate from the iron-modified graphene oxide undera cidic conditions.

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Narrative review shows that the short‐term use of ketorolac is safe and effective in the management of moderate‐to‐severe pain in children

Abstract: The short-term use of ketorolac appears to be safe for children in many situations.

Cited by 14 publications

References 58 publications

Oral ibuprofen versus oral ketorolac for children with moderate and severe acute traumatic pain: a randomized comparative study

Oral ibuprofen versus oral ketorolac for children with moderate and severe acute traumatic pain: a randomized comparative study

Effect of ultrasound on nonsteroidal anti-inflammatory drugs complexed with copper, iron, zinc and graphene oxides

Sonochemical Formation of Copper/Iron‐Modified Graphene Oxide Nanocomposites for Ketorolac Delivery

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