title: Ketorolac vs meperidine for the management of pain in the emergency department.
abstract: OBJECTIVE
  To compare the pain relief, sedation, and common side effect profiles of ketorolac tromethamine and meperidine for the management of acute pain in the emergency department (ED).
  
  
  METHODS
  A prospective, double-blind, randomized clinical trial was conducted over a 12-month period using consecutive adult patients presenting to a university teaching hospital ED (annual census: 32,000), who required IM analgesia for acute pain. Adult patients with acute pain of various etiologies were randomly assigned to receive a single fixed IM dose of ketorolac (60 mg) or meperidine (100 mg).
  
  
  RESULTS
  Ninety-three patients were enrolled in the study; 46 were randomized to meperidine and 47 to ketorolac. Using a visual analog scale, there was no difference in pain relief between the ketorolac and meperidine groups even after adjusting for baseline pain level. Ketorolac caused significantly (p < 0.005) less sedation than did meperidine at one hour. Rescue analgesia was required for seven of the 46 (15.2%) patients receiving meperidine and five of the 47 (10.6%) patients receiving ketorolac (p = NS). Seventeen of 45 (38%) patients receiving meperidine experienced side effects compared with eight of the 47 (17%) patients receiving ketorolac (p = 0.0452).
  
  
  CONCLUSIONS
  When used to treat patients who had acute pain states, 60 mg of IM ketorolac produced analgesia similar to that produced by 100 mg of IM meperidine; however, the ketorolac produced fewer subjective side effects and less sedation than did the meperidine.
authors.affiliation: Highland Hospital Emergency Department, Oakland, CA 94602, USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Koenig
authors.forename: L
authors.initials: L
authors.lastname: Hodgson
authors.forename: R
authors.initials: R
authors.lastname: Kozak
authors.forename: K
authors.initials: K
authors.lastname: Jordan
authors.forename: T R
authors.initials: TR
authors.lastname: Sexton
authors.forename: A M
authors.initials: AM
authors.lastname: Leiken
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003627:Data Interpretation, Statistical; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006801:Humans; D020911:Ketorolac Tromethamine; D008297:Male; D008614:Meperidine / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D011446:Prospective Studies; D014046:Tolmetin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014325:Tromethamine / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; D014325:Tromethamine; D020911:Ketorolac Tromethamine; D008614:Meperidine; D014046:Tolmetin