Ketorolac is a member of the pyrrolo-
pyrrole group of
NSAIDs, and has been available in several formulations for some time, for the treatment of
pain. Intranasal
ketorolac has recently become available. Intranasal
ketorolac was effective in providing short-term relief from
postoperative pain in four well designed, phase II or III trials. In the two phase III trials, a single intranasal dose of
ketorolac 31.5 mg, with or without backup
analgesia, was associated with significantly higher 6-hour summed post-treatment
pain intensity difference scores (primary endpoint) than placebo in adult patients with
acute pain following major surgery, including abdominal and orthopaedic surgery. Intranasal
ketorolac 31.5 mg up to three or four times daily for ≤5 days also had an
opioid-sparing effect in these trials, with significantly less
morphine used among
ketorolac than among placebo recipients over the first 48 hours of treatment. Moreover, a greater proportion of
ketorolac recipients experienced
analgesia onset within 1 and 1.5 hours but not 2 hours than placebo recipients, indicating a more rapid onset with intranasal
ketorolac. In adult patients with
acute pain following major
surgery, intranasal ketorolac 31.5 mg three or four times daily for ≤5 days was generally well tolerated. Most adverse events in clinical trials were considered to be of mild severity and transient in nature, with those in the phase III trials generally being characteristic of common events following major abdominal surgery and
morphine administration.