Ketorolac vs. Fentanyl: A retrospective chart review of analgesia in the prehospital environment

Abstract

BackgroundWith growing concerns on the worsening opioid epidemic and provider hesitation for opioid use, opioid-sparing treatment regimens are being introduced such as ketorolac administration. The primary aims of this study are to compare the safety and efficacy of ketorolac to fentanyl in the prehospital setting and to determine ketorolac's potential as a practical alternative analgesic. MethodsA retrospective chart review of patient encounters obtained from a prehospital emergency medical services agency in New Mexico was conducted to evaluate the safety and efficacy of ketorolac vs. fentanyl in the prehospital setting. Primary outcomes assessed were the reported medication complications, initial pain, last pain, and pain reduction on a Numerical Rating Scale. Data was evaluated using unadjusted and adjusted (age, gender, and weight of the patient) models. ResultsA total of 4102 records were evaluated (3182 fentanyl cases vs. 920 ketorolac cases). No significant differences in initial, last pain or pain reduction were seen in unadjusted models and for age, gender, or weight adjusted models. However, adjusted models displayed a difference in the number of complications that occurred while all cases of medication complications occurred within the fentanyl group (64 occurrences, P<0.0001). Among the complications seen, nausea and hypoxia are the most frequent with 40.6 and 29.7% of occurrences respectively). ConclusionFindings suggest that ketorolac is both effective and safe in the prehospital environment when compared to fentanyl. These findings encourage prehospital agencies to adopt opioid-sparing treatment protocols to encourage increased treatment of pain without potentiating the current opioid epidemic.