Q: In all of the following conditions intravenous (IV) ketorolac should be use with very caution except? 

A) Spine surgery 
B)  Patients with active smoking history
C) Previous long-term NSAID use
D) Creatinine more than or equal to 2 mg/dL.
E)  Age more than 65


Answer:  A

Actually IV ketorolac is an indication to use in spinal surgery, particularly in first 48 hours with dosing recommendations of 15 to 30 mg every six to eight hours, with maximum daily dose of 60 mg.  IV ketorolac decreases need for narcotics and subsequently it side effects.

Concern has been raised about use of IV Ketorolac and spinal nonunion. Though literature nullifies this concern, surgeon should be kept informed with its use.

IV ketorolac should be use with caution in other said conditions.


 Reference: 

Pradhan BB, Tatsumi RL, Gallina J, et al. Ketorolac and spinal fusion: does the perioperative use of ketorolac really inhibit spinal fusion? Spine 2008; 33:2079.