Cost effectiveness analysis of intravenous ketorolac and morphine for treating pain after limb injury: double blind randomised controlled trial

Objectives To investigate the cost effectiveness of intravenous ketorolac c ompared with intravenous morphine in relieving pain after blunt limb injury in an accident and emergency department. Design Double blind, randomised, controlled study and cost consequences ana lysis. Setting Emergency department of a university hospital in the New Territorie s of Hong Kong. Participants 148 adult patients with painful isolated limb injuries (limb i njuries without other injuries). Main outcome measures Primary outcome measure was a cost consequences analy sis comparing the use of ketorolac with morphines; secondary outcome measur es were pain relief at rest and with limb movement, adverse events, patient s' satisfaction, and time spent in the emergency department. Results No difference was found in the median time taken to achieve pain re lief at rest between the group receiving ketorolac and the group receiving morphine, but with movement the median reduction in pain score in the ketor olac group was 1.09 per hour (95% confidence interval 1.05 to 2.02) compare d with 0.87 (0.89 to 1.06) in the morphine group (P = 0.003). The odds of e xperiencing adverse events was 144.2 (41.5 to 501.6) times more likely with morphine than with ketorolac. The median time from the initial delivery of analgesia to the participant leaving the department was 20 (4.0 to 39.0) m inutes shorter in the ketorolac group, than in the morphine group (P = 0.02 ). The mean cost per person was $HK44 (pound4; $5.6) in the ketorolac group and $HK229 in the morphine group (P < 9.0001). The median score for patien ts' satisfaction was 6.0 for ketorolac and 5.0 for morphine (P < 0.0001). Conclusion Intravenous ketorolac is a more cost effective analgesic than in travenous morphine in the management of isolated limb injury in all emergen cy department in Hong Kong, and its use may be considered as the dominant s trategy.