PROLONGED CENTRAL INTRAVENOUS KETOROLAC CONTINUOUS-INFUSION IN A CANCER-PATIENT WITH INTRACTABLE BONE PAIN

OBJECTIVE: TO report the case of a prolonged intravenous ketorolac con tinuous infusion given via a central line in a cancer patient with int ractable bone pain. CASE SUMMARY: A 56-year-old Hispanic man with stag e IV non-small-cell lung cancer and multiple bone metastases was admit ted to the hospital for intractable pain inadequately controlled at ho me by conventional therapy. He was treated with an intravenous continu ous infusion of ketorolac 120 mg in 250 mL of NaCl 0.9% infused over 2 4 hours. The ketorolac was given via a central line for 14 days in add ition to fentanyl patient-controlled analgesia. Over this time period the patient reported his pain to be well controlled. His requests for bolus doses of fentanyl decreased dramatically and the dose of the con tinuous intravenous fentanyl was reduced by 22%. In addition, the tota l daily dose of ketorolac was reduced following a change from intermit tent bolus dosing to a continuous infusion. DISCUSSION: The management of cancer pain secondary to bone metastasis is a difficult and challe nging problem frequently encountered by the healthcare team. The use o f nonsteroidal antiinflammatory drugs (NSAIDs) as adjuvant therapy is a common practice. However, many terminally ill patients are unable to take oral medications, thus limiting NSAID treatment options. Ketorol ac tromethamine is approved by the Food and Drug Administration (FDA) as a parenteral NSAID. As with other NSAIDs, the risk of adverse drug reactions must be considered when using this class of medication. The FDA has approved ketorolac for the short-term (less than or equal to 5 d) management of moderately severe acute pain that requires analgesia at the opioid level, usually in the postoperative setting. However, c ertain patients may benefit from long-term use exceeding the FDA-recom mended guidelines of 5 days of maximum therapy. CONCLUSIONS: A prolong ed central intravenous ketorolac continuous infusion was successful in treating a cancer patient with intractable bone pain secondary to wid ely metastatic non-small-cell lung cancer.