by Nguyen, Brittany N.;
Barta, Ruth J.; Stewart, Christine E.; Heinrich, Cherrie A.
Background: Ketorolac
tromethamine (Toradol), a nonsteroidal antiinflammatory drug, is used with
increased frequency given its success in postoperative pain control and the
subsequent decreased need for narcotics. Its use has been limited in plastic
surgery for fear of postoperative bleeding and hematoma formation. In this
study of breast surgery patients, the authors investigated whether ketorolac
increased the risk of postoperative hematoma formation. Methods: After
obtaining institutional review board approval, the authors retrospectively
reviewed the records of patients undergoing breast surgery from January of 2012
through December of 2014. The authors compared the incidence of postoperative
hematomas in patients who did, versus those who did not, receive ketorolac postoperatively.
Results: For the entire cohort, the overall hematoma rate was 2.8 percent. Of
the patients who received ketorolac, the rate was 3.5 percent; of those who did
not, the rate was 2.5 percent. Of the breast reduction patients, the rate was 4
percent in those who received ketorolac versus 3.2 percent in those who did
not. Of the breast reconstruction patients, the rate was 4 percent in those who
received ketorolac versus 3.2 percent in those who did not. Conclusions:
Recently, the high rates of prescribing postoperative narcotics have received
increased attention. Aside from the risk of increased availability of narcotics
in the community, the side effects can delay patient recovery. Ketorolac is
controversial for postoperative pain control because of the potential risk of
bleeding, but in the authors’ 3-year retrospective study, it was not associated
with an increased risk of hematoma formation. CLINICAL QUESTION/LEVEL OF
EVIDENCE: Therapeutic, III.
