Toradol is a very good drug. It works quickly, especially as an injection. Its analgesic effect lasts four to six hours, though players have claimed it can last until the next day. More importantly, Toradol almost eliminates the need for opiates, which have the insidious side effect of addiction.
The study of the long-term use of milder NSAIDs suggests that Toradol's effect on the kidneys could be transient — all NSAIDs affect kidneys acutely, but stop taking them and normal function returns. But no one can say for sure, and even the people dedicated to studying and treating kidneys don't agree.
Unless you’ve been very committed to keeping your head in the sand, you’ve probably noticed we’re in the midst of an opioid epidemic. Though there is little evidence that the one or two doses of IV opioid medications EMS might give for acute pain contribute to opioid misuse, there are other reasons to have multiple analgesia options in our toolbox.
How much ketorolac do you need to treat a patient’s pain? Historically, it’s been 60mg IM and 30 mg IV. In press in the Annals of Emergency Medicine - Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial found that 10 mg IV was equal in analgesia to 15 and 30 mg. So is more better? In this case, probably not.
Combination of morphine plus ketorolac is more effective at short-term pain reduction than either agent alone in the treatment of acute renal colic.
Also remember, as far as NSAID anti-inflammatory effects go, ketorolac is a lousy anti-inflammatory agent. It’s less effective than ibuprofen, ketoprofen or diclofenac for inflammation. The anti-inflammatory effect of ketorolac is achieved only at doses higher than those needed for analgesia. So if you’re really looking for an inflammatory change, choose something other than ketorolac instead of dosing ketorolac above its analgesic ceiling.
This high-quality RDCT demonstrates that the analgesic ceiling for ketorolac appears to be 10 mg if given intravenously. Administration of higher doses is unlikely to improve analgesic results.
B/R Mag's survey of 50 current players sheds light on pro football's dirty secret: Toradol.
Ketorolac IV is a good non-narcotic analgesic, often given at a dose of 30mg. This RCT found that doses of 10mg, 15mg, and 30mg had equal pain relief. There was no advantage to the larger dose.
Concerns over its widespread use in baseball compelled at least two team doctors to stop using it, according to a medical staff member of a major league team who spoke on condition of anonymity so as not to implicate his team.
Getting regular injections before a start doesn’t seem to fit that indication, but nonetheless, the practice of using Toradol on a regular basis has become prevalent throughout sports. The NFL has most notably developed a dependency on the anesthetic... but apparently baseball is not that far behind.
Feel free to use NSAIDs in your patients with orthopedic injuries (fractures, sprains, etc), but do not use them in patients that have undergone spinal fusion in the previous six weeks, tibial shaft fractures, humerus fractures, non-unions, or in osteotomies...
You don’t need to go very far to find stories of recent NFL players lining up for Toradol, the powerful painkiller they can’t play without. They talk about it the way you might talk about your daily vitamin.
This is a well-conducted study demonstrating no difference in pain score reduction for various doses of IV ketorolac. Doses of 10 mg or 15 mg are just as effective as 30 mg and should be used preferentially over higher doses. Higher doses can cause more adverse effects, especially if more than one dose is administered.
Toradol is a brand-name medication that’s no longer on the market. Today, only its generic version (ketorolac) is available. But many still refer to ketorolac as Toradol.
Toradol's black box warning-which, like all black box warnings, is based on medical studies-states that the drug is intended for "short-term (up to five days in adults), management of moderately severe acute pain…" and that it carries an increased risk to patients for "serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal."
The available evidence indicates that postoperative intravenous ketorolac administration may offer substantial pain relief for most patients, but further research may impact this estimate. Adverse events appear to occur at a slightly higher rate in comparison to placebo and to other NSAIDs.
Despite their daily use for decades, NSAIDs remain sorely misunderstood. I know they’re not a panacea, and they have some serious side effects in certain populations. But for healthy patients without co-morbidities, they are pretty awesome painkillers, with no addictive potential (that I’m aware of).
It has higher demonstrated potency than most other NSAIDs.