Ketorolac in Acute Pancreatitis

Inclusion Criteria:

• 18 years old
• opioid order for pain secondary to acute pancreatitis
• diagnosis of acute pancreatitis defined by the presence of two of the following threecriteria: abdominal pain, lipase > 3x upper limit of normal, and/or findings of AP onimaging
• a patient with acute-on-chronic pancreatitis that does not exhibit elevated lipaselevels is eligible for inclusion if the patient has the other two criteria
• received at least 3 L of IV crystalloid fluid within first 24 hours of admission toensure patients have received initial volume expansion
• hemodynamically stable represented by a mean arterial blood pressure (MAP) of ≥65 mmHg
• female patients not documented in chart as post-menopause must have a negativepregnancy test

Exclusion Criteria:

• history of chronic heart failure
• history of acute coronary syndrome (ST-elevation myocardial infarction (STEMI) ornon-ST elevation myocardial infarction (NSTEMI)) within last 6 months
• history of ischemic or hemorrhagic stroke within last 6 months
• history of upper gastrointestinal bleed (GI) within last 6 months
• history of inflammatory bowel disease
• history of cirrhosis
• any overt, active bleeding requiring blood transfusion
• considered to be high bleed risk (platelet < 50,000/mcL)
• pregnant or breastfeeding
• prisoners
• cognitively impaired patients: not alert and oriented to person, place, and time (patient must be able to consent)
• allergy to NSAIDs, ketorolac, or aspirin
• admission to an intensive care unit
• evidence of infected pancreatitis (i.e. abscess) on imaging studies
• acute kidney injury or chronic kidney disease with CrCl<30