Retrospective analysis of perioperative ketorolac and postoperative bleeding in reduction mammoplasty

• Published in: Canadian journal of anesthesia 2012-05, Vol.59 (5), p.466-472
• Main Authors: Cawthorn, Thomas R., Phelan, Rachel, Davidson, John S., Turner, Kim E.
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Biological and medical sciences; Cardiology; Critical Care Medicine; Drug dosages; Female; Hematoma; Hematoma - epidemiology; Hematoma - etiology; Hematoma - surgery; Humans; Injections, Intravenous; Intensive; Ketorolac - adverse effects; Ketorolac - therapeutic use; Mammaplasty - methods; Medical records; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Narcotics; Pain Medicine; Patients; Pediatrics; Pneumology/Respiratory System; Postoperative Hemorrhage - epidemiology; Postoperative Hemorrhage - etiology; Reports of Original Investigations; Retrospective Studies; Surgeons; Surgery
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/s12630-012-9682-z

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, 1.3 to 3.6). Conclusions 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. Our data suggest that it may be prudent to consider carefully whether the potential risks associated with the use of ketorolac outweigh the potential benefits of using ketorolac in patients undergoing reduction mammoplasty.