IV Ketorolac Effective Alternative to Morphine for Severe Pain Relief among kids, KISS Study
A recent randomized trial published in Indian Pediatrics in January 2025 reveals that IV ketorolac is a powerful alternative to traditional morphine, effectively dropping severe pain scores to 5.56 after 12 hours. Importantly, it delivers this comparable relief while potentially causing fewer minor side effects.
While the provided text does not outline prior background research, specific clinical gaps, or institutional affiliations, primary author Sai Pratap Reddy and colleagues designed the research to directly compare the overall efficacy and safety of administering intravenous ketorolac versus intravenous morphine in the management of severe vaso-occlusive crisis (VOC) in pediatric patients diagnosed with sickle cell disease (SCD).
Therefore, the randomized trial assigned children aged 3 to 15 with severe sickle cell pain crises to receive either IV ketorolac or standard IV morphine. Pain was reassessed every three hours, and medication doses were increased up to three times if severe pain persisted until adequate relief was achieved.
Key Clinical Findings of the Trial Include:
Equitable Baseline Presentations: At admission, the study observed highly comparable initial mean pain scores between the interventional ketorolac group (9.28) and the standard morphine group (9.12), ensuring a balanced starting point (P = 0.636).
Comparable Early Efficacy: The investigation found no statistically significant difference in pain reduction during the early phases of treatment, with mean pain scores at 3 and 6 hours recorded as 8.04 versus 8.28 (P = 0.313) and 7.04 versus 7.28 (P = 0.331), respectively.
Sustained Late Relief: Similarly, the trial documented equivalent therapeutic efficacy at 9 and 12 hours, yielding reduced pain scores of 6.40 versus 6.28 (P = 0.860) and 5.56 versus 5.60 (P = 0.817).
Favorable Safety Profile: Notably, researchers observed minor clinical side effects less frequently in the ketorolac cohort (affecting five children) compared to the morphine cohort (affecting eleven children), though this difference did not reach formal statistical significance (P = 0.069).
Minimal Treatment Failures: Overall, the analysis showed severe pain persisting beyond 12 hours of active therapy was a rare occurrence, affecting only one single patient receiving ketorolac and two patients receiving morphine (P = 0.55).
The results suggest that both therapeutic agents are highly effective at steadily reducing severe pain scores over a comprehensive 12-hour treatment period, bringing the final mean pain scores down to 5.56 for ketorolac and 5.60 for morphine.
Thus, the study concludes for healthcare practitioners that intravenous ketorolac may be confidently considered as a highly viable and safe alternative to traditional opioid-based intravenous morphine regimens when managing acute, severe vaso-occlusive crises in the pediatric sickle cell disease population.
Reference
Reddy, S. P., Jondhale, S. N., Rathia, S. K., Yusuf, S., Shah, S., & Goel, A. K. (2025). Ketorolac vs Morphine for Severe Vaso-Occlusive Crisis in Sickle Cell Disease: An Open-Label Randomized Controlled Trial (KISS Study). Indian Pediatrics, 62, 15–19.
