Management of Acute Trauma Pain in the Emergency Department – A Comparison of Intramuscular Ketorolac, Diclofenac and Tramadol

ABSTRACT

Introduction: Trauma is a chief cause of pain and suffering. Alarge number of studies have shown that pain relief provided topatients in the ED is grossly inadequate. Diclofenac, tramadoland ketorolac are the most commonly used intramuscularanalgesics and hence selected for this comparative study.The aim of this study was to compare the analgesic duration,efficacy and side effect profile of diclofenac, tramadol andketorolac administered intramuscularly in patients whopresented to the ED with acute trauma pain.Material and methods: In a prospective double-blinded study,90 patients presenting to the ED with musculoskeletal traumawere randomly selected and divided into 3 groups - GroupA received 1 ml (50mg) Diclofenac; Group B received 1ml(30mg) Ketorolac; Group C received 1ml (50mg) Tramadol.The efficacy of the drug was measured by observing painscore, onset & duration of action, rescue drug use, and thepatient’s global impression of efficacy of drugs. Collecteddata was analysed using ANOVA.Results: The time taken to administer the first dose of rescueanalgesic was significantly (P <0.05) delayed in the Group B(276mins). Overall, mean scores were significantly better with(Group B) and were not significantly different between other(Group T) and (Group A).Conclusion: Ketorolac was a better analgesic compared todiclofenac and tramadol in managing acute trauma pain.