Tessitore Antimo, Zupin Luisa, Celsi Fulvio, Capaci Valeria, Amaddeo Alessandro, Barbi Egidio, Cozzi Giorgio
Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
Institute for Maternal and Child Health IRCCS Burlo Garofolo of Trieste, Trieste, Italy.
Eur J Pediatr. 2025 Apr 14;184(5):296. doi: 10.1007/s00431-025-06128-2.
Acute pain is a frequent reason for pediatric patients visiting the emergency department (ED). Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are often used to manage pain in this setting. This systematic review and meta-analysis evaluates the effectiveness of ketorolac, a NSAIDs, in managing acute pain in children in the ED, comparing its efficacy and potential advantages over other pain management options. The search was conducted in PubMed and Web of Science, for English-language articles published from 1991 to February 2023. Only randomized controlled trials (RCTs) evaluating the analgesic effect of ketorolac in commonly painful conditions such as migraine, traumatic and non-traumatic musculoskeletal pain, abdominal pain, and renal colic treated in the ED were included. Pediatric studies were specifically selected. A meta-analysis was subsequently conducted to compare efficacy of ketorolac with other analgesic medications. Eight RCTs have investigated the efficacy of ketorolac for acute pain in children in the ED, reflecting limited pediatric evidence. Ketorolac showed variable effectiveness for conditions such as migraine, musculoskeletal trauma, acute abdominal pain, renal colic, and vaso-occlusive crisis in sickle cell disease. The meta-analysis revealed no significant differences in analgesic performance between ketorolac and other drugs, including opioids and other NSAIDs. The risk of bias across the studies was evaluated. However, the evidence remains insufficient to confidently recommend a specific intervention, highlighting the need for further research to guide clinical decision-making.Conclusion: Despite its limitations, the systematic review highlights that ketorolac seems effective for managing acute pain in pediatric ED patients, but not superior to other analgesic drugs. It emphasizes the necessity for further research to define optimal dosing, administration methods, and its comparative effectiveness with other analgesics across various clinical scenarios.
急性疼痛是儿科患者前往急诊科（ED）就诊的常见原因。在这种情况下，非甾体抗炎药（NSAIDs）和阿片类药物常被用于控制疼痛。本系统评价和荟萃分析评估了一种NSAIDs——酮咯酸在急诊科处理儿童急性疼痛方面的有效性，比较了其与其他疼痛管理方案相比的疗效和潜在优势。检索了PubMed和Web of Science，查找1991年至2023年2月发表的英文文章。仅纳入评估酮咯酸在急诊科常见疼痛情况（如偏头痛、创伤性和非创伤性肌肉骨骼疼痛、腹痛和肾绞痛）中的镇痛效果的随机对照试验（RCTs）。特别选取了儿科研究。随后进行荟萃分析，以比较酮咯酸与其他镇痛药物的疗效。八项RCTs研究了酮咯酸在急诊科儿童急性疼痛方面的疗效，这反映出儿科证据有限。酮咯酸在偏头痛、肌肉骨骼创伤、急性腹痛、肾绞痛和镰状细胞病血管闭塞危象等情况中显示出不同的有效性。荟萃分析显示，酮咯酸与其他药物（包括阿片类药物和其他NSAIDs）在镇痛表现上无显著差异。评估了各项研究的偏倚风险。然而，证据仍然不足，无法自信地推荐特定干预措施，这突出表明需要进一步研究以指导临床决策。结论：尽管存在局限性，但该系统评价强调，酮咯酸似乎对急诊科儿科患者的急性疼痛管理有效，但并不优于其他镇痛药物。它强调有必要进一步研究以确定最佳剂量、给药方法及其在各种临床场景中与其他镇痛药相比的有效性。
