Intended for healthcare professionals


Ketorolac versus morphine for severe pain

BMJ 2000; 321 doi: (Published 18 November 2000) Cite this as: BMJ 2000;321:1236

Ketorolac is more effective, cheaper, and has fewer side effects

  1. George A Jelinek (, Professor of emergency medicine
  1. Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009

    papers p 1247

    Morphine, titrated intravenously, is the gold standard analgesic for severe pain in emergencies. It is effective and cheap. But morphine has well documented side effects including drowsiness, nausea and vomiting, and respiratory depression. These side effects can be distressing for patients who are already in severe pain and can also interfere with the efficient flow of patients through emergency departments. Staff must spend time observing patients who are experiencing side effects; the length of the patient's stay in the emergency department is prolonged; and some patients need to be admitted for a short time while they recover from the side effects of morphine, thus adding to overall costs.

    Non-steroidal anti-inflammatory drugs have had the potential to replace opioids in the treatment of severe pain since they became available for use by intravenous injection. The only Cochrane review on this subject shows that non-steroidal anti-inflammatory drugs relieve the pain of renal colic faster when given intravenously than when given by other routes.1 Ketorolac trometamol given intravenously is as effective as morphine in the management of surgical pain and pain …

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