Effect of ketorolac tromethamine on bleeding and on requirements for analgesia after total knee arthroplasty.

Fragen, Robert J.; Stulberg, S.D.; Wixson, Richard L.; Glisson, Silas N.; Librojo, E. S.

doi:10.2106/00004623-199507000-00004

Cited by 61 publications

(19 citation statements)

References 10 publications

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“…12 Ketorolac is effective in relieving postoperative pain following orthopedic surgery and is used in many multimodal protocols. In a comparison of 4 doses of ketorolac to placebo in 59 patients undergoing TKA, 13 ketorolac resulted in a 27% decrease in morphine consumption, without affecting overall blood loss or transfusion rate. However, a 6% increase in blood loss was seen on postoperative day 1, and the authors warned against the use of high doses (120 mg daily) concomitantly with routine anticoagulation.…”

Section: Nonopioid Medications In the Perioperative Periodmentioning

confidence: 99%

Postoperative Pain Management

Nett¹

2010

Orthopedics

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Although the long-term results following traditional total joint arthroplasty are excellent, postoperative pain management has been suboptimal. Under-treatment of pain is a focus of growing concern to the orthopedic community. Poorly controlled postoperative pain leads to undesirable outcomes, including immobility, stiffness, myocardial ischemia, atelectasis, pneumonia, deep venous thrombosis, anxiety, depression, and chronic pain. Over the past decade, the attempt to minimize postoperative complications, combined with the move toward minimally invasive surgery and early postoperative mobilization, has made pain management a critical aspect of joint replacement surgery. Effective protocols are currently available; all include a multimodal approach. Debate continues regarding the ideal approach; however, reliance on narcotic analgesia alone is suboptimal.

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Section: Nonopioid Medications In the Perioperative Periodmentioning

confidence: 99%

Postoperative Pain Management

Nett¹

2010

Orthopedics

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“…These authors found that all 3 NSAIDs caused reversible platelet dysfunction, but ketorolac had the most lasting effect with platelet dysfunction persisting 24 hours after use. The clinical significance of these findings are mixed, as Fragen et al 11 found a statistically significant but clinically unimportant reduction in hematocrit in patients undergoing total knee arthroplasty. Garcia Rodriquez et al 12 investigated the risk of hospitalization for upper GI bleeding associated with ketorolac against other NSAIDs.…”

Section: Side Effects Of Ketorolacmentioning

confidence: 99%

Recommendations of the National Football League Physician Society Task Force on the Use of Toradol^® Ketorolac in the National Football League

Matava

Brater

Gritter

et al. 2012

Sports Health: A Multidisciplinary Approach

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Ketorolac tromethamine (Toradol®) is a non-steroidal anti-inflammatory drug that has potent analgesic and anti-inflammatory properties. It can be administered orally, intravenously, intramuscularly, or via a nasal route. Ketorolac injections have been used for several years in the National Football League (NFL), in both the oral and injectable forms, to treat musculoskeletal injuries and to prevent post-game soreness. In an attempt to determine the appropriate use of this medication in NFL players, the NFL Team Physician Society appointed a Task Force to consider the best available evidence as to how ketorolac should be used for pain management in professional football players. These treatment recommendations were established based on the available medical literature taking into consideration the pharmacokinetic properties of ketorolac, its accepted indications and contraindications, and the unique clinical challenges of the NFL. The Task Force recommended that 1) ketorolac should only be administered under the direct supervision and order of a team physician; 2) ketorolac should not be used prophylactically as a means of reducing anticipated pain either during or after participation in NFL games or practices and should be limited to those players diagnosed with an injury or condition and listed on the teams’ injury report; 3) ketorolac should be given in the lowest effective therapeutic dose and should not be used in any form for more than 5 days; 4) ketorolac should be given in its oral preparation under typical circumstances; 5) ketorolac should not be taken concurrently with other NSAIDs or by those players with a history of allergic reaction to ketorolac, other NSAIDs or aspirin; and 6) ketorolac should not be used by a player with a history of significant gastrointestinal bleeding, renal compromise, or a past history of complications related to NSAIDs.

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“…Peri-operative pain management has markedly improved in TKA and THA over the last 5-10 years. To achieve improved pain management, there have been a number of described regimens, many of which are multimodal in nature and often include potentially nephrotoxic pain control adjuncts (4)(5)(6) . Arthroplasty procedures are associated with blood loss which can, if the patient is under-resuscitated, also negatively impact renal function.…”

Section: Introductionmentioning

confidence: 99%

Risk of Acute Kidney Injury After Primary and Revision Total Hip Arthroplasty and Total Knee Arthroplasty Using a Multimodal Approach to Perioperative Pain Control Including Ketorolac and Celecoxib

Warth

Noiseux

Hogue

et al. 2016

The Journal of Arthroplasty

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Safe and effective perioperative analgesia is instrumental to patient satisfaction and decreasing LOS after TJA. We evaluated rates of acute kidney injury (AKI) in primary and revision TJA using a multimodal pain control regimen including scheduled celecoxib and PRN ketorolac. Postoperative AKI was identified in 43/903 (4.8%) of 903 of patients with adequate preoperative renal function. Those who developed AKI had significantly increased LOS (P < .01), were older, more obese, and more likely to have diabetes (P < .05). With a protocol incorporating NSAIDs in patients without evidence of preoperative renal impairment, there is a 4.8% rate of AKI, which is 2.7 times higher than the reported literature. Acute postoperative kidney injury was significantly correlated with increased LOS and has important patient safety and healthcare-related cost implications.

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Effect of ketorolac tromethamine on bleeding and on requirements for analgesia after total knee arthroplasty.

Cited by 61 publications

References 10 publications

Postoperative Pain Management

Postoperative Pain Management

Recommendations of the National Football League Physician Society Task Force on the Use of Toradol^® Ketorolac in the National Football League

Risk of Acute Kidney Injury After Primary and Revision Total Hip Arthroplasty and Total Knee Arthroplasty Using a Multimodal Approach to Perioperative Pain Control Including Ketorolac and Celecoxib

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Effect of ketorolac tromethamine on bleeding and on requirements for analgesia after total knee arthroplasty.

Cited by 61 publications

References 10 publications

Postoperative Pain Management

Postoperative Pain Management

Recommendations of the National Football League Physician Society Task Force on the Use of Toradol® Ketorolac in the National Football League

Risk of Acute Kidney Injury After Primary and Revision Total Hip Arthroplasty and Total Knee Arthroplasty Using a Multimodal Approach to Perioperative Pain Control Including Ketorolac and Celecoxib

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Product

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Recommendations of the National Football League Physician Society Task Force on the Use of Toradol^® Ketorolac in the National Football League