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Pain ManagementPhase 3KETOROLAC-ICUNCT06819956

Ketorolac at Lower Doses for Analgesic Pain Control in ICU: A Pilot Feasibility Study

A Phase 3 study testing Ketorolac in people with Pain Management, run by University of Alberta at 1 site in Canada.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Opiates are commonly used to control pain in critically ill patients in the ICU. However, increased rates of opiate use in hospital may lead to increased prescription-based opiate dependence after leaving the ICU. This may contribute to the ongoing opiate epidemic across the world. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Pain Management
What is being tested?
Ketorolac
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
30 participants
Where
1 siteCanada
Study dates
23 Jun 2025to Dec 2027
Phase
Phase 3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age > 18 years
  • Admission to intensive care unit (ICU)
  • Participants with pain (Critical Care Pain Observation Tool [CPOT] > 1 and/or self-report pains score >1 on visual analogue scale [VAS] or numerical rating scale [NRS])

Who cannot join

  • Serum Cr > 100 mmol/L for females, and >130 mmol/L for males
  • Ongoing ACEi (angiotensin converting enzyme inhibitor)/ARB (angiotensin receptor blocker) use in ICU
  • Known hyperkalemia > 5.5
  • Pre-existing chronic kidney disease (CKD Stage > 3), defined by a serum Cr > 100 mmol/L for females, and >130 mmol/L for males (at the time of screening, based on pre-hospital stable outpatient baseline values)
  • New acute kidney injury KDIGO Stage > 2 (increased more than > 2-to-3 times in serum creatinine above baseline AND/OR <0.5mL/kg/hour urine output for >12 hours)
  • Pre-existing gastrointestinal bleeding (within 12 weeks of hospital admission, requiring hospitalization or medical evaluation), new peptic ulcer disease, esophagitis, esophageal varices within the last 3 months
Show all 28Show fewer
  • Active gastric / duodenal / peptic ulcer, active GI bleeding
  • Prior contraindications/allergies to NSAIDS or stress ulcer prophylaxis, specifically if a participant has had an anaphylactic reaction (asthma or urticaria) or non-anaphylactic asthma reaction to NSAIDs or any stress ulcer prophylaxis, e.g. proton pump inhibitor, histamine-2-blockers, etc. (e.g. proton pump inhibitor, histamine-2-blockers, etc.)
  • Complete or partial syndrome of ASA-intolerance (e.g. rhinosinusitis, urticaria/angioedema, nasal polyps, asthma)
  • Participants who are not receiving stress ulcer prophylaxis (e.g. proton pump inhibitor, histamine-2-blockers, etc.) while in ICU
  • Any active bleeding (requiring any blood products or adjunctive coagulation agents, any output of blood >100 mL/hr, e.g. chest tube drainage, abdominal cavity drain, etc.)
  • Currently receiving NSAID(s) for another indication
  • Inflammatory bowel disease (e.g. participants with prior diagnosis of Crohn's disease or ulcerative colitis)
  • Receiving probenecid, oxpentifylline or pentoxifylline
  • Active ischemic heart disease (acute myocardial infarction, acute coronary syndrome during current hospital admission)
  • Moderate-severe uncontrolled heart failure (New York Heart Association: Class II-IV)
  • Moderate to severe liver impairment or active liver disease (Operational definition: participants with prior history of Child-Pugh class B (moderate) or C (severe) liver cirrhosis, OR Model for End-Stage Liver Disease-Sodium (MELD-Na) score >25, OR active acute liver failure: severe acute liver injury with encephalopathy and impaired synthetic function International Normalized Ratio (INR) >1.5 with or without pre-existing liver disease)
  • Active cerebrovascular bleeding or stroke (cerebrovascular accident, transient ischemic attacks and/or amaurosis fugax, e.g. participants with active stroke symptoms within current hospital admission)
  • Cerebrovascular bleeding or other bleeding disorders
  • Coagulation disorders, post-operative patients with high haemorrhagic risk or incomplete haemostasis in patients with suspected or confirmed cerebrovascular bleeding
  • Neuraxial (epidural or intrathecal) administration of ketorolac tromethamine injection due to its alcohol content
  • Rhabdomyolysis (creatinine kinase >5000 U/L)
  • Recent transplant (during same hospital admission, e.g., heart, lung, kidney, liver, etc.)
  • Known allergy to ketorolac or other NSAIDs
  • Participants expected to stay in ICU < 48 hours
  • In the opinion of the attending physician, expected death or withdrawal of life-sustaining treatments within 48 hours
  • Participant is known to be pregnant and/or breastfeeding
  • Most responsible physician, participant, or substitute decision maker declines study participation (and reason)

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Vincent I Lau, MD MSc contact

780-492-9390

vince.lau@ualberta.ca

Canada1 site, 1 recruiting
  • University of Alberta Hospital

    Edmonton, Alberta, T6G 2B7

    Vincent I Lau, MD MSc, 780-492-9390, vince.lau@ualberta.ca

    Recruiting

Other trials in Canada

About this study

Official title: Ketorolac at Lower Doses for Analgesic Pain Control in ICU: A Randomized, Blinded, Parallel-Group, Placebo-Controlled Trial to Ascertain the Effect of Ketorolac on Pain Scores and Opiate Use for Critically Ill Patients

Opiates are commonly used to control pain in critically ill patients in the ICU. However, increased rates of opiate use in hospital may lead to increased prescription-based opiate dependence after leaving the ICU. This may contribute to the ongoing opiate epidemic across the world. Other medications that can reduce pain, like non-steroidal anti-inflammatory drugs (NSAIDs), are being studied in critically ill patients. These drugs block the enzyme, cyclooxygenases (COX), which causes inflammation in the body. Blocking these enzymes can decrease pain, fever, and inflammation. Traditionally, NSAIDs are not commonly used in critically ill patients due to the perceived risk of gastrointestinal (GI) bleeding and acute kidney injury (AKI). However, many critically ill patients are already receiving medications and treatments to prevent GI bleeding and AKI and are closely monitored so these medications may be useful in reducing pain for these patients.

The purpose of this study is to see whether NSAIDs can be used safely in critically ill patients to reduce the dose of opiates required for pain control. This is a pilot study or a feasibility study, which is not expected to answer the question definitively. Its main purpose is to determine if NSAIDs could reduce the use of opiates in critically ill patients while in the ICU. The data collected in this study may be used in a larger study in the future.

Read the detailed description

Purpose: The purpose of this study is to determine the feasibility of conducting a future, adequately powered large-scale randomized trial, while evaluating the safety and efficacy of an intravenous NSAID (e.g., ketorolac) plus usual care as compared to placebo plus usual care in critically ill patients.

Hypothesis: The investigators hypothesize that this single-centre pilot study will demonstrate that NSAIDs administration is feasible and safe in ICU patients and may potentially reduce opiate use in ICU patients with pain.

Justification: Pain control in ICU is difficult to achieve given that opiates are the mainstay of analgesia in critically ill patients, but this is not without unintended side effects, especially unintended consequences of possible future drug dependence or addictions. Given that opiates and other adjunctive pain medications (e.g., acetaminophen) are being utilized at high proportional rates, and that NSAIDs are used at relatively low rates (due to the theoretical risk of increased AKI and GI bleeds), there is potential for practice change for increased NSAID use at lower doses to reduce pain and opiate use, while not increasing risks.

Objectives: The primary objective of this pilot trial is to assess the feasibility of a larger clinical trial utilizing NSAIDs in the ICU for patients with pain. The primary outcomes of the pilot feasibility trial are: recruitment and consent rates, proportion of eligible participants who are randomized vs. not randomized, retention and protocol adherence rates.

The secondary objectives are to assess safety of the proposed trial (e.g. gastrointestinal bleeding, acute kidney injury, death) and efficacy outcomes (e.g. participant pain scores, opiate and other analgesia usage).

Research Methods/Procedures: The investigators have designed KETOROLAC-ICU as a pilot randomized controlled trial (prospective, single centre, parallel-group, concealed, blinded) examining the use of low-dose ketorolac for critically ill patients.

Conditions
Pain Management
Being tested
Ketorolac, Placebo
Keywords
analgesia, ketorolac, NSAID, ICU
Medical subject headings
Agnosia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • KetorolacDrug

    Ketorolac 15 mg IV q6h for a maximum of 3 days total or discharge from ICU (whichever comes first). The ketorolac will be diluted in a 0.9% normal saline 10 mL syringe.

  • PlaceboDrug

    Matching placebo IV q6h for a maximum of 3 days total or discharge from ICU (whichever comes first). The matching placebo will be diluted in a 0.9% normal saline 10 mL syringe.

Study groups in NCT06819956
Study groupRoleWhat they receive
KetorolacExperimentalKetorolac administration + standard of care. Participants will not be allowed to have co-administered alternative NSAIDs during the duration of their exposure on the study drug. After each administered dose, overall analgesic requirements should be assessed by the treating team (as per local institutional guidelines and practices), with attempts to wean analgesic infusions or use reduced doses of analgesic medications (especially if objective pain score measures are zero, e.g. CPOT or NRS/VAS).
Receives: Drug: Ketorolac
PlaceboPlacebo comparatorPlacebo administration + standard of care. Participants will not be allowed to have co-administered alternative NSAIDs during the duration of their exposure on the study drug. After each administered dose, overall analgesic requirements should be assessed by the treating team (as per local institutional guidelines and practices), with attempts to wean analgesic infusions or use reduced doses of analgesic medications (especially if objective pain score measures are zero, e.g. CPOT or NRS/VAS).
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Feasibility - Recruitment and Retention

    Recruitment rate at pilot site (participants/month), consent rates of eligible participants, proportion of eligible participants not randomized, and participant retention rates.

    Measured: Days 1-7, 90

  2. Feasibility - Protocol Adherence

    Rates of protocol adherence and reasons for protocol non-adherence.

    Measured: Days 1-7, 90

Secondary outcomes (15)
  1. Opioid Use

    The administration of opioid medications (converted into oral morphine equivalents)

    Measured: Baseline; Days 1-7, 14, 21, 28, 90

  2. Pain Scores - Critical Care Pain Observation Tool (CPOT)

    The critical care pain observation tool (CPOT) is used by healthcare workers to measure four indicators of pain: facial expression, body movements, muscle tension, and compliance with the ventilator (or vocalization for extubated participants). Each of the four indicators are ranked from 0 to 2, with higher numbers describing more pain behaviors.

    Measured: Baseline; Days 1-7, 14, 21, 28

  3. Pain Scores - Visual Analog Scale (VAS)

    The visual analog scale (VAS) is a self-reported measure of a participant's level of pain. This tool consists of a single, 10cm long line, with one end titled "No pain" and the other end titled "Pain as bad as it could possibly be." The participant then draws a mark on the line that corresponds to their level of pain. This mark is later quantified in distance from the "no pain" side of the line.

    Measured: Baseline; Days 1-7, 14, 21, 28

  4. Pain Scores - Numerical Pain Rating Scale (NRS)

    The numerical pain rating scale (NRS) is a self-reported measure of a participant's level of pain. Participants are asked to rank their pain on a scale of 0 to 10, with 0 representing no pain, and 10 representing the worst possible pain.

    Measured: Baseline; Days 1-7, 14, 21, 28

  5. Safety - Acute Kidney Injury

    KDIGO Stage ≥ 2 (increased serum creatinine > 2-3 times above baseline AND/OR <0.5mL/kg/hour urine output for >12 hours) AND/OR need for renal replacement therapy

    Measured: Days 1-7, 28

  6. Safety - Gastrointestinal (GI) Bleeding

    Clinically significant GI bleeding (visual and physiological evidence of overt GI bleeding)

    Measured: Days 1-7, 28

  7. Safety - Other

    Occurrence of any adverse and/or serious adverse events

    Measured: Days 1-28

  8. All-Cause Mortality

    All-cause mortality in ICU, in hospital, or post-discharge.

    Measured: Days 28, 90

  9. Health-Related Quality of Life (EQ-5D-5L)

    EuroQol's Health-Related Quality of Life questionnaire (EQ-5D-5L) is a self-reported measure of a participant's current health status and quality of life. This questionnaire consists of 5 questions, each representing a different dimension of health-related quality of life: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each question has 5 possible responses, ranging from "no problem" (score of 1) to "unable/extreme problems" (score of 5).

    Measured: Day 90

  10. Clinical Frailty Scale (CFS)

    The Clinical Frailty Scale (CFS) is a tool to describe a participant's frailty and level of functioning. This scale ranges from "Very Fit" (score of 1) to "Terminally Ill" (score of 9).

    Measured: Baseline; Day 90

  11. Cognitive Measures

    Delirium incidence (ICDSC scores ≥ 4), duration of decreased level of consciousness (LOC) due to moderate-severe sedation (RASS scores ≤ -3), duration of decreased LOC requiring intubation or ongoing mechanical ventilation (GCS < 8)

    Measured: Days 1-28

  12. Organ Support

    Use and duration of invasive mechanical ventilation (including rates of reintubation), non-invasive ventilation, renal replacement therapy, and vasopressors

    Measured: Days 1-7, 14, 21, 28, 90

  13. Length of Admission

    ICU length of stay, hospital length of stay, readmission episodes

    Measured: Day 90

  14. Procedures

    Need for endoscopy (EGD or colonoscopy), angiography, and/or exploratory laparotomy

    Measured: Days 1-7, 28

  15. Other Analgesia

    Administration of non-opioid analgesic medications

    Measured: Days 1-7, 14, 21, 28, 90

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 Feb 2025
  2. Study start23 Jun 2025
  3. Primary completionDec 2026 (estimated)
  4. Study completionDec 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
30 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06819956
Sponsor's protocol ID
Pro00126948
Acronym
KETOROLAC-ICU
Status last verified
Sep 2026
First submitted
30 Jan 2025
Last updated
28 Sep 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Ketorolac in people with Pain Management, run by University of Alberta at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 28 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 28 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Vincent I Lau, MD MSc (780-492-9390, vince.lau@ualberta.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Feasibility - Recruitment and Retention (time frame: Days 1-7, 90). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Sep 2026.

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