Comparison of Intranasal Ketorolac and Intranasal Ketamine in Digital Nerve Block Pain

This Phase III, randomised, quadruple-masked, parallel trial (n=64) will assess the analgesic effectiveness and side-effect profile of intranasal ketorolac versus intranasal ketamine in adults presenting to the emergency department with finger injuries who require a digital nerve block, with primary outcome block pain intensity measured immediately after the block using the Numeric Rating Scale (NRS). Participants will be randomised to receive either 30 mg intranasal ketorolac tromethamine or 50 mg intranasal ketamine, each administered via mucosal atomizer with half the dose (0.5 cc) in each nostril 5 minutes before the digital nerve block. Secondary endpoints include nasal irritation, other adverse effects and patient satisfaction. Key eligibility criteria include age 18–65 years, weight >50 kg, requirement for digital nerve block and ability to provide informed consent; notable exclusions include pregnancy or breastfeeding, hypersensitivity to NSAIDs, recent analgesic use within 6 hours, significant renal or hepatic failure, nasal congestion or upper respiratory infection and coagulation disorders. The study is sponsored by Tehran University of Medical Sciences and is planned to start on 28 December 2025 with expected completion on 1 August 2026.