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NSAID Dosing and Analgesia - #PHARMFAX

Nonsteroidal antiinflammatories or NSAIDS are extensively used for acute pain control.

 

Nonsteroidal antiinflammatories or NSAIDS are extensively used for acute pain control. Oral ibuprofen and intravenous ketorolac are commonly used non-opioid analgesics used in the emergency department. Even though NSAIDS have been associated with an analgesic ceiling, higher doses are still utilized without improvement in pain control.


No medication is benign and should always be given with purpose. General risks associated with NSAIDS include gastrointestinal bleeding, peptic ulcer disease, acute renal failure, and drug interactions.


Motov and colleagues conducted two studies for oral ibuprofen and IV ketorolac comparing analgesia response to three different doses. In the ibuprofen trial, single doses of 400, 600, and 800 mg were evaluated. Single doses of IV ketorolac 10, 15, and 30 mg were compared. Pain scores were recorded at one hour in the ibuprofen and and 30 minutes for ketorolac trial.


In their respective trials, the lowest studied dose of each NSAID, oral ibuprofen 400 mg and iv ketorolac 10 mg was associated with a similar pain reduction score, both associaand analgesic efficacy compared to the larger doses. No adverse drug reactions were reported and analgesia was not evaluated past their time points.


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References

  1. Forestell et al. Comparative Effectiveness of Ketorolac Dosing Strategies for Emergency Department Patients With Acute Pain. Ann Emerg Med. 2023 May 13;S0196-0644(23)00298-6. doi: 10.1016/j.annemergmed.2023.04.011.

  2. Motov et al. Comparison of Oral Ibuprofen at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med. 2019 Oct;74(4):530-537.

  3. Motov et al. Comparative Effectiveness of Ketorolac Dosing Strategies for Emergency Department Patients With Acute Pain. Ann Emerg Med. 2017 Aug;70(2):177-184. doi: 10.1016/j.annemergmed.2016.10.014.

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