Sickle cell crisis: regular ketorolac reduced pain and hospital stay.

Clinical bottom line (level 1b)

  1. Patients with sickle cell vaso-occlusive crisis who were given regular ketorolac and meperidine (pethidine) prn, had less pain and stayed around three days less in hospital, than those given meperidine alone.
  2. There may be some decrease in the use of meperidine, but it was not clearly different.
Perlin et al: American Journal of Hematology 1994; 46: 43-47
Expires February 2003

The study

Double-blinded ?concealed randomised trial without intention-to-treat
Setting: university hospital, USA

21 patients (aged range 19 to 41 years; mean 28, 50% male) sickle cell anaemia (diagnosed electrophoretically) and admitted with moderate to severe pain for acute vaso-occlusive crisis

Excluded if
  • <15 years old
  • active peptic ulcer disease
  • systemic bleeding disorder
  • impaired renal function (urea >20 mg/dL, creatinine >1 mg/dL)
  • hypersensitive to NSAIDs
  • pregnancy
  • other complicating medical condition


    • Control Group: (n = 11, 9 analysed): placebo
    Experimental Group: (n = 10, 9 analysed): ketorolac , 30 mg loading dose iv, followed by 120 mg at 5 mg/hour for 5-7 days
    All patients were given meperidine (pethidine) 100 mg im every 3 hours prn. If patients continued to have pain after the 5 days, they were given meperidine and hydroxyzine permoate.
    86% followed for 5 days

    The evidence

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    mean daily dose of meperidine (mg) 662
    (68.6)     		524
    (222)     		138
    (-26.2 to 302)
    visual analogue scale score on day 1 72.6
    (10.2)     		58.6
    (10.0)     		14.0
    (3.91 to 24.1)
    visual analogue scale score on day 5 52.9
    (14.9)     		32.4
    (20.8)     		20.5
    (2.42 to 38.6)
    median duration in hospital 7.20
    ()     		3.30
    ()     		3.90
    ( to )

  • Pain was assessed on a visual analogue scale (VAS) of 0-100 mm.
  • p<0.05 for the mean difference in median hospital stay.

    • Citation

    1. Perlin E, Finke H, Castro O, et al: Enhancement of pain control with ketorolac tromethamine in patients with sickle cell vaso-occlusive crisis. American Journal of Hematology 1994; 46: 43-47
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer:

    Clinical Question.
    Patient sickle cell anaemia
    Intervention or Exposure ketorolac tromethamine
    Comparison placebo
    Outcome pain