Perioperative Ketorolac Use and Postoperative Hematoma Formation in Reduction Mammaplasty: A Single-Surgeon Experience of 500 Consecutive Cases

Firriolo, Joseph M.; Nuzzi, Laura C.; Schmidtberg, Lauren C; Labow, Brian I.

doi:10.1097/prs.0000000000004828

Cited by 20 publications

(6 citation statements)

References 30 publications

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“…About 30 minutes prior to completion of the procedure, our institution's specified maximum safe volume of 0.25% bupivacaine hydrochloride with epinephrine is infiltrated subfascially (up to 150 mg if patient weight is ≥60 kg or 1 ml/kg of weight if patient weight is <60 kg), and a dose of intravenous acetaminophen and ketorolac is given unless medically contraindicated. Although some studies have suggested an elevated risk of hematoma formation with ketorolac in patients undergoing reduction mammaplasty, our data do not demonstrate this association (Firriolo et al, 2018).…”

Section: Timing and Techniquecontrasting

confidence: 99%

Reduction Mammaplasty in Younger Patients: An Evidence-Based Approach to Treatment

White,

McNamara,

Nuzzi

et al. 2023

Plastic and Aesthetic Nursing

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Macromastia is a common condition that can lead to physical pain, emotional burden, and behavioral impairment, with significant decrements in quality of life. Reduction mammaplasty offers the only effective treatment of symptomatic macromastia, and patients experience significant improvements in their physical and psychosocial health through surgical correction. Although symptoms typically arise during adolescence, most women seeking surgical intervention do not undergo reduction mammaplasty until their fifth decade of life. Providers often delay surgery due to speculative concerns about emotional immaturity, postoperative breast regrowth, and future lactation performance. The strict guidelines related to age and body mass index imposed by insurance companies further restrict the options available to younger patients with macromastia. This review offers an evidence-based approach to treating macromastia in younger patients. After more than 15 years of treatment and research centered on adolescents and young adults with macromastia led by the senior author (B.I.L.), a pediatric plastic surgeon, we have found that reduction mammaplasty is a safe and effective treatment option for this patient population. It is our hope that our work will enable care providers to make data-supported decisions when treating younger patients with symptomatic macromastia.

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Section: Timing and Techniquecontrasting

confidence: 99%

Reduction Mammaplasty in Younger Patients: An Evidence-Based Approach to Treatment

White,

McNamara,

Nuzzi

et al. 2023

Plastic and Aesthetic Nursing

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“…38,75,78 This fear persists despite studies showing no difference in bleeding risk in adults 44 and children 11,61 undergoing cranial surgery. Similar investigations in orthopedics, 81 spinal surgery, 18 plastic surgery, 59 general surgery, 23 otolaryngology, 7 and other major surgeries 24 have affirmed the safety of postoperative NSAID use, as well as a meta-analysis of 27 studies with 2314 patients across a range of disciplines. 26 Although not directly comparable, the pediatric literature has also shown safety in postoperative NSAID use in children undergoing surgery.…”

Section: Safety Of the Opioid-sparing Protocol In Cranial Surgerymentioning

confidence: 77%

Efficacy of an opioid-sparing analgesic protocol in pain control after less invasive cranial neurosurgery

Ahmad¹,

Khanna²,

Onyewuenyi³

et al. 2021

PR9

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Introduction: Opioid overuse in postoperative patients is a worrisome trend, and potential alternatives exist which warrant investigation. Nonsteroidal anti-inflammatory drug use in treating postoperative cranial surgery pain has been hampered by concern for inadequate pain control and increased risk of hemorrhagic complications. A safe and effective alternative to opioid-based pain management is critical to improving postoperative care. Objective: The objective of this retrospective study was to determine whether an NSAID-based opioid-sparing pain management protocol (OSP) is effective in analgesic control of less invasive cranial surgery patients at 6-, 12-, and 24-hour postoperatively. Secondary aims included investigating differences in hemorrhagic complications. Methods: Five hundred sixty-six consecutive patients who underwent cranial surgery before and after implementation of the celecoxib-based OSP were eligible. Propensity score matching was used to match patients in each cohort. Results: The opioid-sparing cohort had lower pain scores at 6 hours (3.45 vs 4.19, P 5 0.036), 12 hours (3.21 vs 4.00, P 5 0.006), and 24 hours (2.90 vs 3.59, P 5 0.010). Rates of postoperative hemorrhage were not significantly different (5% intervention vs 8% control, P 5 0.527). The opioid-sparing pain management protocol provided comparable or better pain control in the first 24 hours after less invasive cranial surgery. Hemorrhage rates did not change with the use of an NSAID-based OSP. Conclusion: An effective alternative to the current standard opioid-based pain management is feasible for less invasive cranial surgery. Determinations of hemorrhage risk and more complex cranial surgery will require larger prospective randomized trials.

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“…However, the use of ketorolac in reduction mammaplasty patients has been controversial because of fear of increased hematoma risk. Two studies 85,86 found only a slightly increased risk of hematoma associated with perioperative ketorolac that was nonsignificant in otherwise healthy patients. Two additional studies 87,88 showed a minimally increased risk of developing a hematoma after reduction mammaplasty in women who were administered perioperative ketorolac.…”

Section: Rationalementioning

confidence: 98%

American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline Revision: Reduction Mammaplasty

Perdikis

Dillingham

Boukovalas

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Summary: A multidisciplinary work group involving stakeholders from various backgrounds and societies convened to revise the guideline for reduction mammaplasty. The goal was to develop evidence-based patient care recommendations using the new American Society of Plastic Surgeons guideline methodology. The work group prioritized reviewing the evidence around the need for surgery as first-line treatment, regardless of resection weight or volume. Other factors evaluated included the need for drains, the need for postoperative oral antibiotics, risk factors that increase complications, a comparison in outcomes between the two most popular techniques (inferior and superomedial), the impact of local anesthetic on narcotic use and other nonnarcotic pain management strategies, the use of epinephrine, and the need for specimen pathology. A systematic literature review was performed, and an established appraisal process was used to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development and Evaluation methodology). Evidence-based recommendations were made and strength was determined based on the level of evidence and the assessment of benefits and harms.

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Perioperative Ketorolac Use and Postoperative Hematoma Formation in Reduction Mammaplasty: A Single-Surgeon Experience of 500 Consecutive Cases

Abstract: Therapeutic, III.

Cited by 20 publications

References 30 publications

Reduction Mammaplasty in Younger Patients: An Evidence-Based Approach to Treatment

Reduction Mammaplasty in Younger Patients: An Evidence-Based Approach to Treatment

Efficacy of an opioid-sparing analgesic protocol in pain control after less invasive cranial neurosurgery

American Society of Plastic Surgeons Evidence-Based Clinical Practice Guideline Revision: Reduction Mammaplasty

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