Evaluation of IV Ketorolac versus IV Morphine for Severe Vaso-Occlusive Crisis in Children with Sickle Cell Disease

The present study aimed to evaluate and compare the effectiveness and safety of intravenous (IV) ketorolac versus IV morphine for treating severe vaso-occlusive crises (VOC) in children with sickle cell disease (SCD).

An open-label, randomized controlled trial was conducted from January 2021 to July 2022, involving children aged 3 to 15 years with SCD who were experiencing severe VOC (pain score > 6 on the Wong-Baker Faces Pain scale). Participants were randomly assigned to receive either IV ketorolac (treatment group) or IV morphine (control group). Pain levels were measured every three hours, with dosages adjusted accordingly if pain scores remained above 6, up to three additional doses. A pain score of 6 or lower was considered a positive response. 

The findings of the outcome showed:

• At the time of admission, the mean (SD) pain scores for the ketorolac and morphine groups were 9.28 (SD 0.89) and 9.12 (SD 1.01), respectively. 
• Pain scores at 3, 6, 9, and 12 hours post-infusion showed no significant differences between the two groups: 8.04 vs 8.28, 7.04 vs 7.28, 6.40 vs 6.28, and 5.56 vs 5.60. 
• Minor side effects were reported in five children in the ketorolac group and eleven in the morphine group.
• After 12 hours of treatment, one child in the ketorolac group and two in the morphine group continued to experience severe pain.

Thus, the study substantiated that IV ketorolac may serve as an effective alternative to IV morphine for managing severe VOC in children with SCD.

Source: Reddy SP, Jondhale SN, Rathia SK, Yusuf S, Shah S, Goel AK. Ketorolac vs Morphine for Severe Vaso-Occlusive Crisis in Sickle Cell Disease: An Open-Label Randomized Controlled Trial (KISS Study). Indian Pediatr. 2025 Jan 15;62(1):15-19. doi: 10.1007/s13312-025-3351-0. PMID: 39754425.