Faculty Advisor

Dwayne Accardo, DNP, CRNA, APRN

Document Type


Publication Date

Spring 4-24-2022


Analytical, Diagnostic and Therapeutic Techniques and Equipment | Anesthesia and Analgesia | Health and Medical Administration | Investigative Techniques | Medicine and Health Sciences | Mental and Social Health | Nursing | Nursing Administration | Perioperative, Operating Room and Surgical Nursing | Quality Improvement | Substance Abuse and Addiction | Therapeutics


Abstract Purpose/Background Opioids are commonly administered in the perioperative period to manage surgical pain. However, the ongoing opioid epidemic in the United States makes it necessary to evaluate other modalities of pain management that do not cause respiratory depression, nausea, vomiting and addiction. Ketorolac is a nonsteroidal anti-inflammatory drug that can manage pain safely and effectively. This scoping review examines the available literature on the effectiveness and feasibility of using ketorolac to minimize perioperative opioid use.

Methods A comprehensive literature review was performed between October 2020 and September 2021 utilizing five scholarly databases: GoogleScholar ™, PubMed, Ovid, Cochrane Library, and the University of Tennessee Health Science Center (UTHSC) library databases. The key terms searched were “narcotics,” “opioids,” “intraoperative,” “ketorolac,” and “Toradol.” 28 articles met the initial inclusion criteria and were subjected to a rapid critical appraisal by each team member. Fifteen articles were included in the final review and the results of the literature were organized in a synthesis table.

Findings The literature surveyed in this scoping review suggests that perioperative ketorolac administration reduces postoperative opioid consumption and postoperative pain scores in adult patients undergoing a variety of surgical procedures. Furthermore, perioperative ketorolac administration significantly reduced the incidence of PONV and was not associated with any significant adverse effects or negative postoperative outcomes in adult surgical patients. Finally, the authors identified significant heterogeneity in the current data, which limited their ability to provide specific guidance for practice.

Interpretations The scoping review authors suggest that further, more robust, and homogenous studies should be performed regarding the efficacy and safety of ketorolac in the perioperative period. In general, intraoperative ketorolac administration provided sufficient, opioid-sparing analgesia without the adverse effects of narcotics. Ketorolac is a valuable adjunct in a multimodal perioperative analgesia regiment. Anesthesia providers should strongly consider utilizing ketorolac as an alternative to perioperative opioids to improve postoperative patient outcomes and combat the opioid epidemic in America.