Date Published

March 28, 2019

Updated For

ALS PCS Version ALS PCS Version 5.2


Is there really a priority with the delivery of Ketorolac over Tylenol/Ibuprofen in the new pain protocol?


Ketorolac is the preferred analgesia medication for patients with suspected renal colic. From the ALS-PCS v4.5 Adult Analgesia Medical Directive and new AUXILIARY Analgesia Medical Directive Clinical considerations, Suspected renal colic patients should routinely be considered for ketorolac From the ASK MAC 11-Aug-2017, Suspected renal colic patients should routinely be considered for ketorolac administration (meaning, first line) because of the anti-inflammatory action and smooth muscle relaxant effects (reduces the glomerular filtration rate which reduces renal pelvic pressure and stimulation of the stretch receptors) as well as its inhibition of prostaglandin production makes them ideal agents to treat renal colic. Ketorolac should not be administered in conjunction with ibuprofen as they are both NSAIDs and concomitant administration of both would increase the adverse effects The OBHG Companion Document v4.5 adds the additional statement, The only advantage of parenteral ketorolac over ibuprofen is the ability to administer an NSAID despite vomiting. The overall effect of these drugs is almost identical.

In summary: If your patient is able to tolerate oral NSAIDS, it is reasonable to treat with oral ibuprofen, as it has the same clinical effect as ketorolac in all pain processes other than renal colic. However, should your patient not be able to tolerate oral medications, ketorolac is the drug of choice.



Adult Analgesia

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