title: Enhancement of pain control with ketorolac tromethamine in patients with sickle cell vaso-occlusive crisis.
abstract: Twenty one patients with sickle cell disease admitted to the hospital with the pain of vaso-occlusive crisis (VOC) were treated by continuous IV infusion of ketorolac or normal saline for up to 5 days. All patients received supplemental IM injections of meperidine, 100 mg, as necessary, but not more frequently than every 3 hr. Over the 5 days the ketorolac treated patients (KT) required 33% less meperidine than did the placebo treated patients (PL), P = 0.04, and had significantly better pain relief as assessed by categorical, visual analog, and pain relief scales. By the end of 5 days infusions had been discontinued in six KT and one PL. The time to discontinuation of the infusion was significantly shorter in KT, (P = 0.009). The median duration of hospital stay from the start of treatment was 3.3 days for KT and 7.2 days for PL, P = 0.027. Adverse events were mainly related to the digestive system. This study showed that continuous infusion of ketorolac significantly reduced total meperidine requirement and that the analgesia produced by this combination was superior to that produced by meperidine alone. Further evaluation of this drug in the management of sickle cell VOC is warranted.
authors.affiliation: Department of Medicine, Howard University Hospital, Washington, D.C. 20060.
authors.forename: E
authors.initials: E
authors.lastname: Perlin
authors.forename: H
authors.initials: H
authors.lastname: Finke
authors.forename: O
authors.initials: O
authors.lastname: Castro
authors.forename: S
authors.initials: S
authors.lastname: Rana
authors.forename: J
authors.initials: J
authors.lastname: Pittman
authors.forename: R
authors.initials: R
authors.lastname: Burt
authors.forename: C
authors.initials: C
authors.lastname: Ruff
authors.forename: D
authors.initials: D
authors.lastname: McHugh
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000755:Anemia, Sickle Cell / Q000150:complications*; D003251:Constriction, Pathologic / Q000188:drug therapy / Q000209:etiology; D004066:Digestive System Diseases / Q000139:chemically induced; D004311:Double-Blind Method; D004338:Drug Combinations; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D020911:Ketorolac Tromethamine; D008297:Male; D008614:Meperidine / Q000627:therapeutic use; D010147:Pain Measurement; D010166:Palliative Care; D010919:Placebos; D014046:Tolmetin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014325:Tromethamine / Q000009:adverse effects / Q000627:therapeutic use*; D014652:Vascular Diseases / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D000700:Analgesics; D004338:Drug Combinations; D010919:Placebos; D014325:Tromethamine; D020911:Ketorolac Tromethamine; D008614:Meperidine; D014046:Tolmetin