Retrospective analysis of perioperative ketorolac and postoperative bleeding in reduction mammoplasty

Abstract

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,

Post‐operative pain relief using local infiltration analgesia during open abdominal hysterectomy: a randomized, double‐blind study

“…Our findings confirm previous studies using LIA technique in patients undergoing hip and knee arthroplasty and remains unique since it has not previously been used in other types of surgeries. One concern using this technique was the potential risk of surgical site bleeding because of the infiltration of ketorolac . We found that the overall incidence of surgical complications including bleeding was similar to or lower than previous studies…”

Single dose systemic acetaminophen to improve patient reported quality of recovery after ambulatory segmental mastectomy: A prospective, randomized, double-blinded, placebo controlled, clinical trial

“…This is particularly important in this patient population, since clinicians frequently avoid nonsteroidal anti-inflammatory drugs in patients undergoing breast surgery to minimize the risk of postsurgical bleeding. 20 It was interested to note that we did not detect a beneficial effect of the systemic acetaminophen on analgesia during the immediate (PACU) postsurgical period. More elapsing time was likely needed to achieve the peak effect of the drug and this probably explains the late but not early analgesic effect of the drug in the current study.…”

“…To the best of our knowledge, the use of a single dose systemic acetaminophen to improve analgesic outcomes after breast surgery has not been yet tested. This is particularly important in this patient population, since clinicians frequently avoid nonsteroidal anti‐inflammatory drugs in patients undergoing breast surgery to minimize the risk of postsurgical bleeding …”

The Use of NSAIDs in the Postoperative Period: Advantage and Disadvantages

“…In contrast, a recent study of Friedman et al have shown no increased risk of bleeding also when non-steroidal anti-inflammatory drugs or aspirin is associated to dabigratan in patients undergone to hip or total knee arthroplasty [124]. Considering other types of surgery, an increased risk of bleeding is reported in breast surgery and in gastric bypass surgery during ketorolac administration for which the Authors suggest a caution on administration of NSAIDs [125,126]. In particular a single perioperative intravenous dose of ketorolac was associated with a greater than three-fold increase in the likelihood of requirement for surgical hematoma evacuation.…”