Ketorolac as a Local Analgesic in Orthopaedic Conditions: A Systematic Review of Safety and Efficacy

Abstract

Effective pain management is essential in the treatment of musculoskeletal pathology. Corticosteroid injections have long been used both locally and systemically for their analgesic and anti-inflammatory properties in orthopedic conditions. Opioids have long been used in the perioperative setting to optimize pain control, however both corticosteroids and opioids are not without harm. Ketorolac, a nonsteroidal anti-inflammatory (NSAID) has shown to be effective as an anti-inflammatory and analgesic agent in and outside the perioperative setting with less risk of local and systemic side effects. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant publications were identified searching the PubMed database and EMBASE. The initial search totaled 3,978 articles. After thorough review, 21 full text manuscripts were included (Fig. 1 – PRISMA Chart). 21 full text manuscripts were reviewed assessing over 3,100 who received a local injection of Toradol. Overall, the studies reviewed universally demonstrated an excellent safety profile for ketorolac both systemically and locally. Clinical studies have shown that local application of ketorolac demonstrated decreased postoperative pain, decreased lengths of hospital stays, and decrease postoperative opioid use. This is the first ever study to assess the efficacy, safety profile, and postoperative outcomes with local use of ketorolac injections in musculoskeletal pathology. The local use of ketorolac in the intra-articular and peri-articular setting provides a safe and effective adjunct or alternative treatment in patients with musculoskeletal ailments.