Ketorolac use following hysterectomy: A review of postoperative safety

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Created On: 10/09/2026

Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), is commonly utilized to reduce postoperative pain and limit opioid exposure.

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Key take away

Routine postoperative ketorolac use does not increase bleeding complications after hysterectomy and may provide a safe opioid-sparing pain management option.

Background

Ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), is commonly utilized to reduce postoperative pain and limit opioid exposure. However, concerns regarding NSAID-associated platelet inhibition and perioperative bleeding have limited its use in some surgical settings.

Evidence regarding the bleeding safety of ketorolac specifically after hysterectomy remains limited. This retrospective cohort study therefore evaluated whether postoperative ketorolac administration is linked with an increased risk of bleeding complications following hysterectomy for benign indications.

Method

Overall, 4,236 patients who underwent hysterectomy for benign indications at a quaternary care academic hospital between 2015 and 2024 were included. Those undergoing hysterectomy for malignancy or in the peripartum period were excluded. Postoperative complications occurring within 30 days of surgery were assessed. The key outcome was a composite of postoperative bleeding complications, defined as transfusion, readmission, or reoperation for bleeding.

Multivariable regression analysis evaluated the association between postoperative ketorolac use and bleeding while adjusting for age, American Society of Anesthesiologists (ASA) category, preoperative celecoxib use, anticoagulant treatment, uterine size, surgical approach, increased surgical complexity, and lysis of adhesions.

Result

Of the 4,236 patients, 76% (n = 3,236) received postoperative ketorolac.

The composite postoperative bleeding rate was 2.1% with ketorolac vs. 4.1% without ketorolac (p = 0.001).
Multivariable analysis illustrated no pivotal association between ketorolac use and postoperative bleeding (adjusted odds ratio [aOR], 1.02).
No significant differences were noted in overall perioperative or intraoperative complications (p = 0.070 for both).
Major perioperative complications were less frequent among those receiving ketorolac (p = 0.046).
Among postoperative complications, ileus was less frequent in the ketorolac group (p = 0.034), while no other vital differences were identified.
No increase in bleeding complications was identified with preoperative celecoxib use within an enhanced recovery pathway.

Conclusion

The study provided reassuring real-world evidence that routine postoperative ketorolac does not increase bleeding complications after hysterectomy. Its lack of association with transfusion, readmission, or reoperation for bleeding supports ketorolac as a viable opioid-sparing analgesic strategy in postoperative gynecologic care.