Thirteen trials (782 participants) were included. Some trials included more than one comparison. Sample sizes ranged from 20 to 126. The median score on the modified Jadad scale was 4.
Early (zero to four hours) pain at rest: Overall, ketorolac was associated with less early pain at rest than placebo (WMD -0.64, 95%CI -1.11 to -0.17, 14 comparisons). A dose of 30mg ketorolac was not associated with statistically significant less early pain at rest than placebo (three trials). A dose of 60mg ketorolac was associated with less early pain at rest (WMD -2.09, 95% CI -3.24 -0.95, 11 comparisons). There was evidence of high heterogeneity in this analysis (Ι²=93%).
Early (zero to four hours) pain at movement: Both pre-incision (WMD -3.00, 95% CI -4.38 to -1.61) and post-incision (WMD -1.90, 95% CI -3.28 to -0.51) administration of 60mg ketorolac reduced early pain at movement (one trial). No trials investigated use of 30mg ketorolac.
Late (24 hours) pain at rest: Overall, ketorolac did not significantly reduce late pain at rest compared with placebo (eight trials). Neither 30mg (two trials) nor 60mg (six comparisons) ketorolac were associated with a statistically significant reduction of late pain at rest.
Late (24 hours) pain at movement: Neither pre- nor post-incision administration of 60mg ketorolac reduced late pain at movement (one trial). No trials investigated use of 30mg ketorolac.
Post-operative opioid consumption: Overall, ketorolac significantly reduced post-operative opioid consumption (WMD-1.73 milligrams, 95% CI -2.82 to -0.59, 14 comparisons). A dose of 30mg ketorolac did not significantly reduce post-operative opioid consumption (four comparisons). There was evidence of heterogeneity in this analysis (Ι²=37%). A dose of 60mg ketorolac significantly reduced post-operative opioid consumption (WMD -1.64 milligrams, 95%CI -2.90 to -0.37) compared with placebo (10 comparisons). There was evidence of heterogeneity present in this analysis (Ι²=71%).
Post-operative nausea and vomiting: Overall, ketorolac reduced post-operative nausea and vomiting compared with placebo (OR 0.57, 95% CI 0.36 to 0.88, NNT 12.5, 10 comparisons). A dose of 30mg ketorolac did not significantly reduce post-operative nausea and vomiting (three trials). But a dose of 60mg ketorolac did significantly reduce post-operative nausea and vomiting (OR 0.50, 95%CI 0.29 to 0.85, seven comparisons).
Other Adverse events: Most included trials did not report on adverse events. Ketorolac was associated with a significant increase in abnormal bleeding (OR 2.43, 95% CI 0.5 to 11, two trials). Ketorolac did not significantly increase post-operative gastritis symptoms (two trials).
There was no evidence of funnel plot asymmetry in these analyses. Other results were reported in the review.