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Ketorolac successfully controls postoperative pain and shows no significant increase in perioperative bleeding or overall adverse events.
A comprehensive meta-analysis of randomized controlled trials (RCTs) confirms that ketorolac, a potent nonsteroidal anti-inflammatory drug (NSAID), does not elevate the risk of perioperative or postoperative bleeding, challenging long-standing concerns among surgeons and anesthesiologists.
The study, led by Ryan M Gobble, reviewed 27 double-blind, randomized trials encompassing 2,314 patients to determine the safety and efficacy of ketorolac in postoperative pain management. Researchers analyzed the incidence of adverse events, including bleeding, using comprehensive meta-analysis software. Results revealed that postoperative bleeding occurred in 33 of 1,304 patients (2.5%) receiving ketorolac compared to 21 of 1,010 patients (2.1%) in control groups. Statistical analysis exhibited no prominent difference between the groups (odds ratio [OR] 1.1).
Overall adverse events were comparable, impacting 27.9% of ketorolac-treated patients versus 31.7% of controls (OR 0.64). Interestingly, low-dose ketorolac was linked with a considerably lower incidence of adverse effects (OR, 0.49). In terms of pain control, ketorolac illustrated superior efficacy compared to placebo or standard care and was equivalent to opioid analgesics, making it an attractive alternative for postoperative pain management while potentially minimizing reliance on opioids.
The findings support its safety profile and effectiveness, suggesting that ketorolac should be strongly considered for postoperative pain relief, particularly in the context of efforts to minimize opioid use.
Plastic and Reconstructive Surgery
Ketorolac does not increase perioperative bleeding: a meta-analysis of randomized controlled trials
Ryan M Gobble et al.
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