Ketorolac provides opioid-strength postoperative analgesia, but its use as a single agent is limited to a maximum of five days. The principal reason for this restriction is:

• A Rapid induction of tolerance and dependence
• B Progressive loss of analgesic efficacy beyond 72 hours
• C High incidence of serious gastrointestinal bleeding and renal injury with prolonged use ✓
• D Cumulative bone marrow suppression

Explanation

Ketorolac is the most potent NSAID analgesic and is non-sedating and non-dependence-forming, but prolonged use carries a sharply rising incidence of peptic ulceration, gastrointestinal haemorrhage, acute kidney injury and surgical-site bleeding from irreversible platelet COX-1 inhibition. Hence labels limit parenteral use to five days. Tachyphylaxis does not explain the limit, marrow suppression is not a recognised effect, and its analgesic potency persists, so the restriction reflects organ toxicity rather than waning efficacy.

Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.

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