Date Published

September 29, 2016

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: In regards to the adult analgesia medical directive, it states "in patients with isolated hip or extremity trauma, ibuprofen and acetaminophen are preferred to ketorolac except where the patient is unable to tolerate oral medications." It is my understanding that together, they provide similar pain relief to ketorolac. If the patient is in severe pain, but is unable to take acetaminophen due to a contraindication (ex. due to having taken some in the past 4 hours), is it appropriate to administer ketorolac instead? Or is it still preferred to administer just the Ibuprofen at this point.


Great question.  Luckily, just Ibuprofen alone has been found to have as equally efficacious as ketorolac.  The added benefit of acetaminophen (if the patient be able to tolerate it) would be even more efficacious than ketorolac alone.  Which is why it is recommended, if tolerated.

  1. Neibor ML, Puntillo KA. Intramuscular ketorolac vs oral ibuprofen in emergency department patients with acute pain.  Acad Emerg Med. 1998;5(2):118-22.
  1. Schwartz NA et al. Patients' perceptions of route of nonsteroidal anti-inflammatory drug administration and its effect on analgesia. Acad Emerg Med.  2000;7(8):857-61.



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