Comparison of Intranasal Ketorolac and Intranasal Ketamine in Digital Nerve Block Pain

Acute pain management in emergency department during painful procedures such as digital nerve block is crucial to be implemented in a rapid-onset method. Ketorolac, a potent NSAID, and ketamine, an NMDA receptor antagonist with analgesic effects, have both been shown to be effective and fast-onset when administered intranasally. This non-invasive method of Ketorolac is not supported by sufficient evidences in such clinical scenarios. Addressing this research gap may lead to reduced pain and complications, as well as higher patient satisfaction, contributing the development of novel pre-procedural analgesic strategies in emergency settings.

Participants will be randomly assigned to receive either 30 mg intranasal ketorolac or 50 mg intranasal ketamine, administered 5 minutes prior to the digital nerve block. Pain will be assessed using the Numeric Rating Scale (NRS). Secondary endpoints include nasal irritation, side effects, and patient satisfaction.

Inclusion criteria

• Age: 18-65 years
• Weight > 50 kg
• Requires digital nerve block
• Able to provide informed consent

Exclusion criteria

• Active peptic ulcer disease (PUD)
• History of hypersensitivity to NSAIDs
• Pregnancy and breastfeeding
• Renal failure
• Hepatic failure
• Patients who have received analgesics within the past 6 hours
• Nasal congestion
• Upper respiratory tract infection
• Patients with a history of kidney transplantation
• Active gastrointestinal bleeding
• Systolic blood pressure less than 90 mmHg or greater than 180 mmHg
• Heart rate less than 50 per minute or greater than 150 per minute
• Concurrent use of NSAIDs or anticoagulant drugs
• Inability to provide informed consent
• Anatomical abnormalities of the nose or skull base (congenital or acquired)
• Hyperreactive airway disease such as severe asthma
• Coagulation disorders
• Intracranial hemorrhage
• Suspected aortic dissection
• Suspected rupture of abdominal aortic aneurysm
• History of gastrointestinal perforation
• Gastrointestinal bleeding within the past month