The International Journal of Medical Science and Health Research
Effectiveness of injectable ketorolac for acute exacerbations of sciatic pain with a history of long-term adjuvant piroxicam therapy: A case report
By Virdo Novian Firnako and Irda Rein Christina.
Abstract
Background
Acute pain exacerbations in chronic sciatica patients previously controlled with long-term oral NSAIDs present a unique clinical challenge, as they require rapid-acting analgesia while taking into account prior NSAID exposure. Ketorolac is a non-selective parenteral NSAID with analgesic potency comparable to opioids, frequently utilized as rescue therapy for moderate-to-severe acute pain in emergency and inpatient settings.
Objective
This report aims to evaluate the effectiveness of ketorolac injection in an acute exacerbation of sciatic pain with a history of long-term piroxicam therapy.
Methods
A 62-year-old female presented with sudden low back pain accompanied by tingling radiating down both legs, rendering her unable to walk properly, following a bending motion to lift heavy groceries. The patient had a 10-year history of chronic ischialgia/sciatica controlled with oral piroxicam. On examination, her blood pressure was 148/96 mmHg, and her heart rate was 107 bpm. The pain score upon arrival was 8–9/10 on the Numeric Rating Scale (NRS), accompanied by an antalgic gait requiring assistance to walk. The Straight Leg Raise (Lasegue) test, Patrick's test, and Contra-Patrick's test were positive bilaterally. AP/LAT lumbosacral X-rays revealed paravertebral muscle spasm and spondylosis with mild intervertebral space narrowing at the L5–S1 level. The patient received an injection of ketorolac along with supplemental oxygenation.