Objectives: To critically evaluate the efficacy and safety of intranasal (IN) ketorolac in managing acute pain among both adult and pediatric populations. Methods: A thorough search across four databases identified 1233 relevant publications. After removing duplicates using Rayyan QCRI and screening for relevance, the search yielded 593 publications, of which 101 full-text articles were reviewed, and 5 met the eligibility criteria for evidence synthesis. Results: We included 5 studies with a total of 1417 patients and 566 (39.9%) were males. This review provides comparable pain relief results of IN ketorolac to opioids while potentially reducing opioid use. Its administration was linked to fewer unplanned medical visits, demonstrating effective pain control. In pediatric migraine, it showed similar efficacy to IV ketorolac, offering a non-invasive alternative. For renal colic, it provided comparable relief to IV ketorolac and fentanyl, supporting its use in emergency care. In postoperative patients, it significantly reduced opioid consumption while ensuring high analgesic effectiveness and patient tolerance. Conclusion: This review confirms that IN ketorolac is an effective, well-tolerated, and opioid-sparing option for acute pain management in both adult and pediatric patients. It provides analgesia equivalent to opioids and IV NSAIDs, making it a valuable non-invasive alternative, particularly in pediatric, emergency, and postoperative settings. However, while current evidence is promising, further long-term studies are needed to establish its safety, optimal dosing, and long-term efficacy. Given the growing concerns about opioid dependence, IN ketorolac represents a promising addition to multimodal pain management, contributing to safer and more effective pain control strategies.

Keywords: Keywords: Analgesia; Ketorolac; Intranasal; Acute pain; Management; Systematic review.