Oral Ibuprofen and ketorolac equally effective in adolescents with acute traumatic musculoskeletal pain

The present study by Dr Sergio Ghirardo and colleagues from the University of Trieste compared Ibuprofen and ketorolac for children with trauma-related acute pain.

This multicentre, randomised, double-blind controlled study compared a single dose of oral Ibuprofen 10 mg/kg+placebo to ketorolac 0.5 mg/kg+placebo for moderate and severe acute traumatic pain in Italian children and adolescents.

The study points are:

• The study was conducted in the Paediatric Emergency Department setting.
• The researchers enrolled 212 patients aged 8 to 17 years.
• In 125 patients with severe pain, 63 were randomised to Ibuprofen and 62 to ketorolac.
• Amon 87 children with moderate pain, 43 children were randomised to Ibuprofen and 44 children to ketorolac.
• Self-reported numeric rating scale-11 (NRS-11) pain scores in patients with severe pain declined by 2 points at 60 minutes in Ibuprofen and 1 point in the ketorolac group.
• At 90 minutes, a higher proportion of patients experienced a pain score decline of >3 points in patients receiving Ibuprofen vs ketorolac.
• In patients taking either Ibuprofen or ketorolac, there were no observed differences in moderate pain reduction (1.63 for Ibuprofen and 1.8 for ketorolac)

To conclude, Oral ketorolac drops and oral ibuprofen syrup have similar effectiveness in providing relief of moderate and severe acute traumatic pain in children and adolescents presenting in an emergency department (ED) setting.

The limitations of the study include, Moderate pain sample being underpowered and Investigators being unable to demonstrate the noninferiority of 1 agent vs another for moderate pain

As acknowledged, the study received Funding from the Institute for Maternal and Child Health.

Further reading:

Ghirardo S, Trevisan M, Ronfani L, Zanon D, Maestro A, Barbieri F, De Nardi L, Amaddeo A, Barbi E, Cozzi G. Oral ibuprofen versus oral ketorolac for children with moderate and severe acute traumatic pain: a randomised comparative study. Eur J Pediatr. 2022 Dec 17:1–7. doi: 10.1007/s00431-022-04759-3.