BACKGROUND: Ketorolac tromethamine is a non-steroidal anti-inflammatory drug (NSAIDs) that is widely used in the emergency department (ED) for the treatment of moderate-to-severe pain. Ketorolac, like other NSAIDs, exhibits an analgesic ceiling effect and previous research suggests that 10 mg is possibly the ceiling dose. Do the patterns of ketorolac dosing by emergency physicians follow its analgesic ceiling dose? METHODS: This was a single center retrospective, descriptive study to characterize patterns of ketorolac administration in ED patients. Data for all patients who received ketorolac during the ten year study period from January 1, 2003 to January 1, 2013 were collected from the electronic medical record of an urban community ED with an annual volume of 116935 patients. RESULTS: There were 49605 ketorolac administrations during the study period; 38687 (78%) were given intravenously, 9916 (20%) intramuscularly, and 1002 (2%) orally. Through the intravenous route, 5288 (13.7%) were 15 mg, 32715 (84.6%) were 30 mg, 15 (0.03%) were 60 mg, and 669 (1.7%) were other varying doses. Through the intramuscular route, 102 (1.0%) were 15 mg, 4916 (49.6%) were 30 mg, 4553 (45.9%) were 60 mg, and 345 (3.5%) were other varying doses. The most common diagnoses at discharge were renal colic (21%), low back pain (17%) and abdominal pain (11%). CONCLUSION: The data show that ketorolac was prescribed above its ceiling dose of 10 mg in 97% of patients who received intravenous doses and in 96% of patients receiving intramuscular doses.

BACKGROUND: We describe our experience of utilizing sub-dissociative dose ketamine (SDK) in managing a variety of acute and chronic painful conditions in the emergency department (ED). METHODS: A descriptive study was conducted in our ED over a period of seven years (2010–2016) by retrospectively reviewing charts of patients aged 18 and older presenting to the ED with painful complaints and receiving SDK analgesia. Primary data analyses included type of SDK administration (intravenous push [IVP], short-infusion [SI] or continuous infusion [CI]), dosing, rates of analgesic utilization before and after SDK administration, and adverse effects. RESULTS: Three hundred sixty-two patients were enrolled in the study. Mean ketamine doses given by IVP, SI and CI were 26.3 mg, 23.4 mg, and 11.3 mg. The mean duration of CI was 135.87 minutes. The percentage of patients not requiring post-SDK analgesia increased by 16％, 18％, and 37％ in IVP, SI and CI groups. Adverse effects were recorded for 13％ of patients. CONCLUSION: SDK administered by IVP, SI, and CI in the ED for a variety of painful conditions is a feasible analgesic modality in the ED that is associated with a decrease in overall requirements of post-ketamine analgesia and opioid sparing.

Pain is one of the most common reasons for patients to visit the emergency department. The ever-growing research on emergency department analgesia has challenged the current practices with respect to the optimal analgesic regimen for acute musculoskeletal pain, safe and judicious opioid prescribing, appropriate utilization of non-opioid therapeutics, and non-pharmacological treatment modalities. This clinical review is set to provide evidence-based answers to these challenging questions.

BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs)in the USA from 2007 to 2018. METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS)from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period. RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3％from 2007(244,000 visits)to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8％to 57.6％),female patients(from 54.5％to 62.0％),black patients(from 22.5％to 30.4％),and Hispanic/Latino patients(from 9.4％to 19.6％).Oxycodone/acetaminophen was most prescribed and accounted for 90.2％of all oxycodone-containing analgesics in 2007,with a decrease to 68.5％in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1％in 2007 and 31.5％in 2018. CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.

BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs)in the USA from 2007 to 2018. METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS)from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period. RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3％from 2007(244,000 visits)to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8％to 57.6％),female patients(from 54.5％to 62.0％),black patients(from 22.5％to 30.4％),and Hispanic/Latino patients(from 9.4％to 19.6％).Oxycodone/acetaminophen was most prescribed and accounted for 90.2％of all oxycodone-containing analgesics in 2007,with a decrease to 68.5％in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1％in 2007 and 31.5％in 2018. CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.

BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs)in the USA from 2007 to 2018. METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS)from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period. RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3％from 2007(244,000 visits)to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8％to 57.6％),female patients(from 54.5％to 62.0％),black patients(from 22.5％to 30.4％),and Hispanic/Latino patients(from 9.4％to 19.6％).Oxycodone/acetaminophen was most prescribed and accounted for 90.2％of all oxycodone-containing analgesics in 2007,with a decrease to 68.5％in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1％in 2007 and 31.5％in 2018. CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.

BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs)in the USA from 2007 to 2018. METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS)from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period. RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3％from 2007(244,000 visits)to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8％to 57.6％),female patients(from 54.5％to 62.0％),black patients(from 22.5％to 30.4％),and Hispanic/Latino patients(from 9.4％to 19.6％).Oxycodone/acetaminophen was most prescribed and accounted for 90.2％of all oxycodone-containing analgesics in 2007,with a decrease to 68.5％in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1％in 2007 and 31.5％in 2018. CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.

BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs)in the USA from 2007 to 2018. METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS)from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period. RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3％from 2007(244,000 visits)to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8％to 57.6％),female patients(from 54.5％to 62.0％),black patients(from 22.5％to 30.4％),and Hispanic/Latino patients(from 9.4％to 19.6％).Oxycodone/acetaminophen was most prescribed and accounted for 90.2％of all oxycodone-containing analgesics in 2007,with a decrease to 68.5％in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1％in 2007 and 31.5％in 2018. CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.

BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs)in the USA from 2007 to 2018. METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS)from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period. RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3％from 2007(244,000 visits)to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8％to 57.6％),female patients(from 54.5％to 62.0％),black patients(from 22.5％to 30.4％),and Hispanic/Latino patients(from 9.4％to 19.6％).Oxycodone/acetaminophen was most prescribed and accounted for 90.2％of all oxycodone-containing analgesics in 2007,with a decrease to 68.5％in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1％in 2007 and 31.5％in 2018. CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.

BACKGROUND:To describe trends in oxycodone and oxycodone-containing analgesic prescribing for the treatment of back pain among adults in emergency departments(EDs)in the USA from 2007 to 2018. METHODS:Data were gathered from the National Hospital Ambulatory Medical Care Survey(NHAMCS)from 2007 to 2018.The study population included individuals of all ages presenting to USA EDs.The NHAMCS reasons for visit and oxycodone drug ID codes were used to isolate patients with back pain.The main outcome was the proportion of oxycodone and oxycodone-containing analgesics prescribed for back pain in the EDs over the specified time period. RESULTS:There was a relative decrease in the overall administration of oxycodone for back pain in the EDs by 62.3％from 2007(244,000 visits)to 2018(92,000 visits).The proportion of ED patients prescribed with oxycodone-containing analgesics for back pain increased among patients aged 45 years and older(from 43.8％to 57.6％),female patients(from 54.5％to 62.0％),black patients(from 22.5％to 30.4％),and Hispanic/Latino patients(from 9.4％to 19.6％).Oxycodone/acetaminophen was most prescribed and accounted for 90.2％of all oxycodone-containing analgesics in 2007,with a decrease to 68.5％in 2018.Pure oxycodone was the second most prescribed medication,accounting for 6.1％in 2007 and 31.5％in 2018. CONCLUSION:The overall number of oxycodone-containing analgesics decreased significantly from 2007 to 2018.However,that number trended upward in 45-year-old and older,female,black,or Hispanic/Latino patients from 2007 to 2018.The total amount of pure oxycodone increased significantly from 2007 to 2008.