comparative efficacy and safety of ketorolac and ketamine in the management of traumatic chest pain: a narrative review

Traumatic chest pain, commonly resulting from rib fractures and blunt thoracic trauma, poses a significant analgesic challenge. ketorolac (a nonsteroidal anti-inflammatory drug) and ketamine (an n-methyl-d-aspartate receptor antagonist) are widely used as opioid-sparing alternatives. this narrative review aimed to synthesize and critically appraise the literature comparing ketorolac and ketamine for pain management in traumatic chest injuries, focusing on efficacy, safety, and clinical applicability. evidence suggests that ketamine provides faster and superior short-term analgesia, particularly among patients requiring chest tube insertion. at the same time, ketorolac is associated with reduced opioid consumption and lower pulmonary complication rates in rib fracture cohorts. most findings were derived from indirect comparisons, with only one direct head-to-head randomized controlled trial (rct) available. both agents demonstrate favorable safety profiles, though ketamine may cause transient psychedelic effects, and ketorolac may cause bleeding or renal risks in high-risk populations. given the limited direct comparative data, clinicians may consider ketamine for rapid analgesia and ketorolac for opioid-sparing benefits, tailoring choice to patient-specific factors. future research should include well-designed rcts comparing combination versus monotherapy, optimal dosing strategies, and long-term outcomes. due to the paucity of direct comparative trials, conclusions rely primarily on indirect evidence and a single head-to-head study.