For most types of moderate to severe acute pain, I believe it is highly overrated as a sole agent. You frequently hear folks refer to studies that show that 30mg of ketorolac is equivalent to 10mg of morphine, but I've always questioned the reality - or at least the reliability - of that equivalence. I wonder if the authors of those studies (or those who cite them) would be content with toradol as the sole analgesic following any type of abdominal surgery, for instance? We all know the answer to that. And this coming from someone (myself) with almost 6 years of experience doing opioid-free (not multimodal, or opioid-sparing....opioid FREE) anesthesia and acute pain management. Thinking about the mechanism of ketorolac vs opioids, it just doesn't make sense that it could ever work as well as an opioid for severe pain.
That said, it is awesome as the sole agent for most types of mild-moderate pain, or as an adjunct for moderate-severe pain. I think in EMS there is probably a lot of opportunity to try it before pulling out the fentanyl or ketamine if the pain is not severe, and if the dose of toradol does not provide sufficient analgesia, then if nothing else you can probably at least cut your narcotic dose in half to start.
