The Efficacy and Safety of Ketamine or Ketorolac Compared to Opioids in Painful Vaso-Occlusive Crisis: A Systematic Review and Meta-Analysis.

This article systematically reviews and meta-analyzes randomized controlled trials to evaluate the efficacy and safety of ketamine and ketorolac compared to opioids in managing acute painful vaso-occlusive crisis (VOC) in sickle cell disease (SCD). Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), demonstrated statistically significant greater pain reduction and a lower risk of adverse effects compared to opioids, while ketamine showed comparable pain relief but a higher incidence of adverse effects, particularly central nervous system-related symptoms. Both ketamine and ketorolac significantly reduced opioid requirements, supporting their roles as opioid-sparing agents. The findings suggest ketorolac may be a safer and more effective nonopioid analgesic option for acute VOC pain management, whereas ketamine may be reserved as adjunctive or second-line therapy with careful consideration of its safety profile. These results inform individualized pain management strategies aiming to reduce opioid-related complications in patients with SCD.