Ketorolac After Free Tissue Transfer: A Comparative Effectiveness Study

• Published in: Annals of otology, rhinology & laryngology rhinology & laryngology, 2014-06, Vol.123 (6), p.446-449
• Main Authors: Schleiffarth, J. Robert, Bayon, Rodrigo, Chang, Kristi E., Van Daele, Douglas J., Pagedar, Nitin A.
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Aspirin - therapeutic use; Bone Transplantation; Comparative Effectiveness Research; Female; Head and Neck Neoplasms - surgery; Humans; Ketorolac - therapeutic use; Male; Middle Aged; Pain, Postoperative - drug therapy; Platelet Aggregation Inhibitors - therapeutic use; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - methods; Retrospective Studies; Tissue Transplantation - adverse effects
• ISSN: 0003-4894; 1943-572X
• DOI: 10.1177/0003489414526849

Objective: We sought to compare postoperative pain and complications in patients undergoing free tissue transfer for reconstruction of head and neck defects with and without ketorolac. Methods: In this retrospective cohort study, we identified patients who underwent head and neck free tissue transfer procedures at the University of Iowa between July 2010 and December 2012. A subset of patients received ketorolac as an anti-platelet agent. Main outcome measures include postoperative analgesic use, pain scores, and bleeding complications. Results: We identified 138 free tissue transfers, with 42 procedures in the ketorolac cohort. In the first 7 postoperative days, patients in the ketorolac and non-ketorolac cohorts received equivalent narcotic doses (morphine equivalents, 48.9 mg/day vs 46.6 mg/day, P = .72). The ketorolac group reported higher mean pain scores (3.1 vs 2.4, P = .004). Ketorolac use was not associated with need for transfusion (P = .86) or number of days with neck drains (P = .79). Conclusion: Ketorolac did not demonstrate a significant analgesic effect in this group of patients in terms of pain scores and opioid requirements. However, there also was no evidence to suggest a higher likelihood of bleeding complications. Ketorolac may be safely used as an anti-platelet agent, with narcotic requirements unchanged.