Ketorolac Use in Rib Fractures

Risk Assessment and Patient Factors

• Rib fractures occur in up to 40% of trauma patients with overall mortality around 10%, with higher rates in elderly patients 1
• Risk factors that predict increased complications include age >60 years, SpO2 <90%, obesity or malnutrition, multiple rib fractures, smoking or chronic respiratory disease, anticoagulation therapy, and major trauma 1

Analgesic Approach and Ketorolac Use

• Thoracic epidural and paravertebral blocks are considered gold standard for rib fracture analgesia, but for less severe cases or when regional techniques are contraindicated, a multimodal approach including ketorolac can be effective 1, 3
• Acetaminophen should be included in the multimodal approach 1, 5
• Low-dose ketamine can be an alternative to opioids with comparable analgesic efficacy 1

Ketorolac Dosing and Contraindications

• Ketorolac should be initiated with IV or IM dosing, with 60 mg IM every 15-30 minutes (maximum 120 mg/day) for patients 17-64 years 2
• Avoid ketorolac in patients with aspirin/NSAID-induced asthma, and use with caution in elderly patients 2
• Contraindicated in pregnancy and cerebrovascular hemorrhage 2

Clinical Algorithm for Ketorolac Use

• Assess risk factors and severity of rib fractures, and consider regional anesthesia as first-line for high-risk patients 1, 4
• For moderate risk or when regional techniques are contraindicated, start with IV ketorolac and combine with scheduled acetaminophen 1, 2, 4