Bleeding Risk With Ketorolac After Lumbar Microdiscectomy

Chin, Kingsley R.; Sundram, Hariharan; Marcotte, Paul J.

doi:10.1097/01.bot.0000211163.51605.ae

Cited by 27 publications

(16 citation statements)

References 13 publications

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“…The results suggest no relationship between ketorolac use and radiographic or clinically significant bleeding events in the postoperative period. In combination with previous studies regarding the efficacy of ketorolac in decreasing narcotic usage, 1,2,5,11,14,15,20,23 as well as the rationale for minimizing the use of sedating medications following neurosurgery, this study supports ketorolac as an option in the perioperative setting among the pediatric neurosurgical population. The role of perioperative ketorolac in pediatric neurosurgery should be further explored through larger prospective studies.…”

Section: Discussionsupporting

confidence: 76%

“…Some clinical safety studies have demonstrated that administration of NSAIDs leads to an increase in postoperative bleeding events, 3,9,10,19,20 whereas other studies have demonstrated the NSAIDs can be safely administered postoperatively. 11,13,14,17,18,23,25,26,28 Since 2000, we have routinely used ketorolac as a component of the perioperative analgesic regimen during the first 72 hours following pediatric neurosurgical procedures. We sought to assess whether this strategy was associated with an increased risk for hemorrhagic or systemic complications.…”

mentioning

confidence: 99%

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Routine perioperative ketorolac administration is not associated with hemorrhage in pediatric neurosurgery patients

Richardson¹,

Williams

Torok

et al. 2016

Journal of Neurosurgery: Pediatrics

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OBJECT NSAIDs are effective perioperative analgesics. Many surgeons are reluctant to use NSAIDs perioperatively because of a theoretical increase in the risk for bleeding events. The authors assessed the effect of routine perioperative ketorolac use on intracranial hemorrhage in children undergoing a wide range of neurosurgical procedures. METHODS A retrospective single-institution analysis of 1451 neurosurgical cases was performed. Data included demographics, type of surgery, and perioperative ketorolac use. Outcomes included bleeding events requiring return to the operating room, bleeding seen on postoperative imaging, and the development of renal failure or gastrointestinal tract injury. Variables associated with both the exposure and outcomes (p < 0.20) were evaluated as potential confounders for bleeding on postoperative imaging, and multivariable logistic regression was performed. Bivariable analysis was performed for bleeding events. Odds ratios and 95% CIs were estimated. RESULTS Of the 1451 patients, 955 received ketorolac. Multivariate regression analysis demonstrated no significant association between clinically significant bleeding events (OR 0.69; 95% CI 0.15–3.1) or radiographic hemorrhage (OR 0.81; 95% CI 0.43–1.51) and the perioperative administration of ketorolac. Treatment with a medication that creates a known bleeding risk (OR 3.11; 95% CI 1.01–9.57), surgical procedure (OR 2.35; 95% CI 1.11–4.94), and craniotomy/craniectomy (OR 2.43; 95% CI 1.19–4.94) were associated with a significantly elevated risk for radiographically identified hemorrhage. CONCLUSIONS Short-term ketorolac therapy does not appear to be associated with a statistically significant increase in the risk of bleeding documented on postoperative imaging in pediatric neurosurgical patients and may be considered as part of a perioperative analgesic regimen. Although no association was found between ketorolac and clinically significant bleeding events, a larger study needs to be conducted to control for confounding factors, because of the rarity of these events.

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Section: Discussionsupporting

confidence: 76%

mentioning

confidence: 99%

Routine perioperative ketorolac administration is not associated with hemorrhage in pediatric neurosurgery patients

Richardson¹,

Williams

Torok

et al. 2016

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

show abstract

“…For example, in a study of patients undergoing lumbar discectomy, a single dose of intraoperative intravenous ketorolac provided effective pain control with no observed difference between groups with respect to bleeding-related complications. 13 Likewise, Vitale et al conducted a retrospective review of 208 children who underwent scoliosis surgery, and they determined that postoperative ketorolac administration was not associated with an increased requirement for blood transfusion or reoperation. 14 In contrast, RuDusky et al…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of perioperative ketorolac and postoperative bleeding in reduction mammoplasty

Cawthorn

Phelan

Davidson

et al. 2012

Can J Anesth/J Can Anesth

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Purpose We conducted a retrospective review following concerns involving a suspected increase in the requirement for surgical re-exploration for hematoma evacuation when ketorolac was administered perioperatively in patients undergoing reduction mammoplasty. Methods Following ethics approval, a retrospective chart review was conducted of all patients who underwent reduction mammoplasty at our two institutions from the time ketorolac became available in 2004 until surgeons requested its use discontinued in 2007. The data we collected included patient demographics, ketorolac administration, requirement for surgical re-exploration, documented hematoma formation not requiring surgical re-exploration, and excessive bleeding in the perioperative period. Three hundred and seventy-nine patient records were reviewed; 127 of the patients received a single intravenous dose of ketorolac (15 or 30 mg), and 252 of the patients did not receive ketorolac.Results Patients who received ketorolac were at an increased risk of requiring surgical re-exploration for hematoma evacuation (relative risk [RR] = 3.6; 95% confidence interval [CI], 1.4 to 9.6) and hematoma formation not requiring re-exploration (RR = 2.2; 95% CI,

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“…Even though there is a paucity of literature in the use of ketorolac with hand procedures in particular, it has been looked at in the spine literature where Chin et al 53 found no risk of bleeding complications compared with that of their control group in patients having microdiscectomy after a single intraoperative dose of ketorolac.…”

Section: Ketorolacmentioning

confidence: 99%