title: Ketorolac tromethamine use in a university-based emergency department.
abstract: OBJECTIVE
  To assess the use of parenteral ketorolac tromethamine (KT) in the emergency department (ED).
  
  
  METHODS
  During a six-month period, KT was administered in an uncontrolled, nonblinded fashion to a series of ED patients experiencing acute pain. The patients rated pain on a previously validated visual analog pain scale before receiving KT. They repeated this procedure one hour after KT administration, prior to additional analgesia, or preceding release, whichever came first. Analgesic response was assessed by comparing pretreatment and posttreatment pain scores for the entire study population by the Wilcoxon rank sum test. Possible effects of specific variables (patient age, gender, race, indication for KT, route, dose, previous use of NSAIDs, and concurrent administration of muscle relaxants) were assessed using the Kruskal-Wallis test.
  
  
  RESULTS
  Of the 445 patients enrolled, 375 (84%) reported pain relief with KT, only seven (2%) worsened, and the remainder (14%) reported no change. Overall pain reduction was 37.6 +/- 27.2 (SD) mm (100-mm scale) for the entire study population. The pain scores obtained after KT administration were significantly lower than those obtained prior to KT administration (p < 0.001). The only variable that significantly influenced pain score reduction was indication for KT (p = 0.001). Nephrolithiasis and toothache patients had the largest mean reductions in pain. No significant side effect was reported.
  
  
  CONCLUSIONS
  Parenteral KT is a useful and safe analgesic for ED patients. The agent generally provides analgesia and is particularly promising for patients with nephrolithiasis or toothache.
authors.affiliation: Department of Emergency Medicine Albany Medical College, NY 12208 USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Bartfield
authors.forename: A M
authors.initials: AM
authors.lastname: Kern
authors.forename: N
authors.initials: N
authors.lastname: Raccio-Robak
authors.forename: H S
authors.initials: HS
authors.lastname: Snyder
authors.forename: R H
authors.initials: RH
authors.lastname: Baevsky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002648:Child; D003085:Colic / Q000188:drug therapy; D016001:Confidence Intervals; D004338:Drug Combinations; D005260:Female; D006801:Humans; D020911:Ketorolac Tromethamine; D007669:Kidney Calculi / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D011446:Prospective Studies; D014046:Tolmetin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014098:Toothache / Q000188:drug therapy; D014325:Tromethamine / Q000627:therapeutic use*
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; D014325:Tromethamine; D020911:Ketorolac Tromethamine; D014046:Tolmetin