Document Type : Original Article


1 Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

4 Department of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran

5 Radiation Biology Research Center, Iran University of Medical Sciences.Tehran, Iran


Objective: Pain is usually one of the most common symptoms among all traumatic injuries. One of the drugs that has recently entered the Iranian prehospital emergency system is ketorolac. Ketorolac is a non-steroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis by inhibiting cyclooxygenase activity and reduces pain and inflammation. It can be considered as the strongest analgesic drug in this category. The aim of this study was to evaluate the effectiveness of ketorolac in pain management of traumatic injuries in a prehospital setting.
Methods: This descriptive cross-sectional study was undertaken to evaluate the effectiveness of a treatment method in the pain management of traumatic injuries in the prehospital environment of Lorestan province in Iran. We included 134 injured patients from road emergency bases of Lorestan province. In order to control the pain of these injured patients, 30 mg of ketorolac was injected slowly intravenously in one minute. Pain was measured in the time interval of zero minutes (before injection), 15 minutes, 30 minutes, and 45 minutes by visual acuity scale (VAS). The analysis of the obtained data was performed by SPSS software version 23.
Results: The mean age of participants was 37.42±23.6. There were 47 female injuries (35.1%) and 87 male injuries (64.9%). In terms of pain intensity, 49 patients (36.6%) had moderate pain (VAS = 4-6) and 85 patients (63.4%) had severe pain (VAS = 7-10). The average of pain relief in the injured group with severe and moderate pain 15 minutes after the injection was 0.471 and 0.878 (P = 0.001), respectively. In addition, the mean of pain relief in the injured group with severe and moderate pain 30 minutes after the injection was 1.124 and 1.796, respectively (P = 0.001). Pain reduction in the group of severely injured patients with moderate pain in the first 30 minutes was statistically significant.
Conclusion: Findings revealed that ketorolac is a suitable drug in pain management for trauma patients with moderate and severe pain in trauma patients. On the other hand, due to the peak effect (more than 30 minutes), it is not an effective drug for trauma patients with severe pain in a short period transferred to the prehospital environment.


Main Subjects

1. Rhee P, Joseph B, Pandit V, Aziz H, Vercruysse G, Kulvatunyou N, et al. Increasing trauma deaths in the
United States. Ann Surg 2014; 260(1): 13-21. doi: 10.1097/sla.0000000000000600.
2. Ahmadi A, Bazargan-Hejazi S, Heidari Zadie Z, Euasobhon P, Ketumarn P, Karbasfrushan A, et al. Pain management in trauma: a review study. J Inj Violence Res 2016; 8(2): 89-98.doi: 10.5249/jivr.v8i2.707.
3. Dijkstra BM, Berben SA, van Dongen RT, Schoonhoven L. Review on pharmacological pain management in trauma patients in (pre-hospital) emergency medicine in the Netherlands. Eur J Pain 2014; 18(1): 3-19. doi:10.1002/j.1532-2149.2013.00337.x.
4. Khan MS, Shuaib W, Evans DD, Swain FR, Alweis R, Mehta AS, et al. Evidence-based practice: best imaging practice in musculoskeletal disorders. J Trauma Nurs 2014; 21(4): 170-9. doi:10.1097/jtn.0000000000000059.
5. Berben SA, Meijs TH, van Grunsven PM, Schoonhoven L, van Achterberg T. Facilitators and barriers in pain
management for trauma patients in the chain of emergency care. Injury 2012; 43(9): 1397-402. doi: 10.1016/j.injury.2011.01.029.
6. Katzung BG, Trevor AJ. Basic & Clinical Pharmacology, SMARTBOOK™. McGraw Hill Professional; 2014.
7. Mallinson DTE. A review of ketorolac as a prehospital analgesic. Journal of Paramedic Practice 2019; 11(11): 1-6.doi: 10.12968/jpar.2019.11.11.CPD1.
8. Farahmand S, Shafazand S, Alinia E, Bagheri-Hariri S, Baratloo A. Pain management using acupuncture method in migraine headache patients; a single blinded randomized clinical trial. Anesth Pain Med 2018; 8(6): e81688. doi:10.5812/aapm.81688.
9. Yousefifard M, Askarian-Amiri S, Madani Neishaboori A, Sadeghi M, Saberian P, Baratloo A. Pre-hospital pain management; a systematic review of proposed guidelines. Arch Acad Emerg Med 2019; 7(1): e55.
10. Ellerton J, Milani M, Blancher M, Zen-Ruffinen G, Skaiaa SC, Brink B, et al. Managing moderate and severe pain in mountain rescue. High Alt Med Biol 2014; 15(1): 8-14. doi:
11. Delavar Kasmaei H, Amiri M, Negida A, Hajimollarabi S, Mahdavi N. Ketorolac versus magnesium sulfate in migraine headache pain management; a preliminary study. Emerg (Tehran) 2017; 5(1): e2.
12. Neri E, Maestro A, Minen F, Montico M, Ronfani L, Zanon D, et al. Sublingual ketorolac versus sublingual tramadol for moderate to severe post-traumatic bone pain in children: a double-blind, randomised, controlled trial. Arch Dis Child 2013; 98(9): 721-4. doi: 10.1136/archdischild-2012-303527.
13. Mahshidfar B, Rezai M, Abbasi S, Farsi D, Hafezimoghadam P, Mofidi M, et al. Intravenous acetaminophen vs. ketorolac in terms of pain management in prehospital emergency services: a randomized clinical trial. Adv J Emerg Med 2019; 3(4): e37. doi: 10.22114/ajem.v0i0.130.
14. Faridaalaee G, Mohammadi N, Merghati SZ, Keyghobadi Khajeh F, Naghipour B, Pouraghaei M, et al. Intravenous morphine vs intravenous ketofol for treating renal colic; a randomized controlled trial. Emerg (Tehran) 2016; 4(4):202-6.
15. Eftekharian HR, Ilkhani Pak H. Effect of intravenous ketorolac on postoperative pain in mandibular fracture surgery; a randomized, double-blind, placebo-controlled trial. Bull Emerg Trauma 2017; 5(1): 13-7.