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Ketorolac Does Not Increase Perioperative Bleeding: A Meta-Analysis of Randomized Controlled Trials

Gobble, Ryan M. M.D.; Hoang, Han L. T. M.D.; Kachniarz, Bart B.A.; Orgill, Dennis P. M.D., Ph.D.

Plastic and Reconstructive Surgery: March 2014 - Volume 133 - Issue 3 - p 741–755
doi: 10.1097/01.prs.0000438459.60474.b5
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Background: Postoperative pain control is essential for optimal patient outcomes. Ketorolac is an attractive alternative for achieving pain control postoperatively, but concerns over postoperative bleeding have limited its use.

Methods: Computer searches of the MEDLINE, EMBASE, and Cochrane Library databases were performed. Twenty-seven double-blind, randomized, controlled studies were reviewed by two independent investigators for the incidence of adverse events, including postoperative bleeding. Comprehensive meta-analysis software was used to evaluate the differences between ketorolac and control groups.

Results: Twenty-seven studies with 2314 patients were analyzed. Postoperative bleeding occurred in 33 of 1304 patients (2.5 percent) in the ketorolac group compared with 21 of 1010 (2.1 percent) in the control group (OR, 1.1; 95 percent CI, 0.61 to 2.06; p = 0.72). Adverse events were similar in the groups, 31.7 percent in the control group and 27.9 percent in the ketorolac group (OR, 0.64; 95 percent CI, 0.41 to 1.01; p = 0.06). There was a lower incidence of adverse effects with low-dose ketorolac (OR, 0.49; 95 percent CI, 0.27 to 0.91; p = 0.02). Pain control with ketorolac was superior to controls and equivalent to opioids.

Conclusions: This is the first meta-analysis of randomized controlled trials examining whether there is increased postoperative bleeding with ketorolac. Postoperative bleeding was not significantly increased with ketorolac compared with controls, and adverse effects were not statistically different between the groups. Pain control was found to be superior with ketorolac compared with controls. Ketorolac should be considered for postoperative pain control, especially to limit the use of opioid pain medications.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Boston, Mass.; and New York, N.Y.

From the Harvard Plastic Surgery Combined Residency Program and the Division of Plastic Surgery, Brigham & Women’s Hospital, and Harvard Medical School; and New York University Langone Medical Center.

Received for publication June 18, 2013; accepted September 9, 2013.

Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Dennis P. Orgill, M.D., Ph.D., Brigham and Women’s Hospital, 75 Francis Street, Boston, Mass. 02115, dorgill@partners.org

©2014American Society of Plastic Surgeons