Preoperative ketorolac increases bleeding after tonsillectomy in children

Splinter, William M.; Rhine, Elliot J.; Roberts, David W.; Reid, Craig W.; MacNeill, Helen B.

doi:10.1007/bf03011766

Cited by 107 publications

(41 citation statements)

References 14 publications

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“…12 These results differ from other tonsillectomy studies which determined that children who underwent tonsillectomy with pre-or intraoperative ketorolac were at an increased risk of postoperative bleeding-related complications. 16,17 Given the incongruent reports, it appears likely that many factors may influence the risk of postoperative bleeding-related complications with ketorolac administration, including timing of administration and the procedure itself. The ketorolac product insert states that ''perioperative Toradol use should be avoided and postoperative use undertaken with caution when hemostasis is critical''.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of perioperative ketorolac and postoperative bleeding in reduction mammoplasty

Cawthorn

Phelan

Davidson

et al. 2012

Can J Anesth/J Can Anesth

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Purpose We conducted a retrospective review following concerns involving a suspected increase in the requirement for surgical re-exploration for hematoma evacuation when ketorolac was administered perioperatively in patients undergoing reduction mammoplasty. Methods Following ethics approval, a retrospective chart review was conducted of all patients who underwent reduction mammoplasty at our two institutions from the time ketorolac became available in 2004 until surgeons requested its use discontinued in 2007. The data we collected included patient demographics, ketorolac administration, requirement for surgical re-exploration, documented hematoma formation not requiring surgical re-exploration, and excessive bleeding in the perioperative period. Three hundred and seventy-nine patient records were reviewed; 127 of the patients received a single intravenous dose of ketorolac (15 or 30 mg), and 252 of the patients did not receive ketorolac.Results Patients who received ketorolac were at an increased risk of requiring surgical re-exploration for hematoma evacuation (relative risk [RR] = 3.6; 95% confidence interval [CI], 1.4 to 9.6) and hematoma formation not requiring re-exploration (RR = 2.2; 95% CI,

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Section: Discussionmentioning

confidence: 99%

Retrospective analysis of perioperative ketorolac and postoperative bleeding in reduction mammoplasty

Cawthorn

Phelan

Davidson

et al. 2012

Can J Anesth/J Can Anesth

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“…8 Although ketorolac is a promising analgesic, trials for tonsillectomies have suggested an increased risk of post-operative bleeding. 9,10 This finding however is not consistent. 6 The fear of bleeding has lead many otolaryngologists and anesthesiologists avoid ketorolac in tonsillectomies and other conditions that may have an increased risk of bleeding.…”

Section: Introductionmentioning

confidence: 66%

“…That being said, pediatric tonsillectomy studies have demonstrated increased risk of bleeding with ketorolac 9,10 . This finding however is not consistent.…”

Section: Discussionmentioning

confidence: 99%

“…Bleeding, although uncommon, is the most common complication suffered by these children receiving ketorolac. 10 Overall, the favorable side effect profile of ketorolac is balanced by concerns of post-operative bleeding. With circumcision being a high volume pediatric urological procedure, we sought to evaluate the bleeding outcomes of children receiving ketorolac for circumcision.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of bleeding in children undergoing circumcision with ketorolac administration

Gao

Remondini

Dhaliwal

et al. 2017

CUAJ

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Introduction: Circumcision is the most common surgical procedure performed by pediatric urologists. Ketorolac has been shown to have an efficacy similar to morphine in multimodal analgesic regimens without the commonly associated adverse effects. Concerns with perioperative bleeding limit the use of ketorolac as an adjunct for pain control in surgical patients. As such, we sought to evaluate our institutional outcomes with respect to ketorolac and postoperative bleeding. Methods: We retrospectively reviewed all pediatric patients undergoing circumcision from January 1, 2014 to December 31, 2015 at the Alberta Children's Hospital. Demographics, perioperative analgesic regimens, and return to emergency department or clinic for bleeding were gathered through chart review. Results: A total of 475 patients undergoing circumcisions were studied, including 150 (32%) who received perioperative ketorolac and 325 (68%) There was no significant difference in the number of patients requiring postoperative admission or further medical intervention. Conclusions: Although a promising analgesic, ketorolac requires additional investigation for safe usage in circumcisions due to possible increased risk of bleeding. CUAJ -Original Research Gao et al Use of ketorolac in circumcision IntroductionCircumcision is a common surgical intervention in pediatric urology indicated in instances of refractory balanitis, pathological phimosis, or paraphimosis. The control of post-operative pain is essential in order to decrease patient morbidity and to improve patient and parent satisfaction. Methods to reduce post-operative morbidity in circumcision include the use of general anesthesia combined with regional block. Common regional blocks include dorsal penile nerve blocks (DPNB) or caudal epidural blocks (CB). Neither has been shown to be more effective than the other in terms of the need for rescue or other analgesia.1,2 DPNB may be preferred over CB in

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“…8 Ce danger continue de prEoccuper le monde de l'anesthEsie et est maintenant le sujet d'un article. 9 II est reconnu que les AINS exag~rent le saignement parce qu'il sont capable d'entraver le fonctionnement des plaquettes. Du point de vue historique, il est intEressant de noter que Singer a publiE en 1945 un article signalant aux clinicients que I'aspirine pouvait provoquer des hEmorragies exagErEes apffzs l'amygdalectomie, t~ L'influence des AINS sur la tbnction des plaquettes isolEes comme sur les autres mesures de la coagulation a EtE EtudiEe `5 profusion chez le patient normal et Eveil-IE.…”

Section: L' Amygdalectomie Leunclassified

Tonsillectomies, ketorolac, and the march of progress

Hall

1996

Can J Anaesth

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Preoperative ketorolac increases bleeding after tonsillectomy in children

Cited by 107 publications

References 14 publications

Retrospective analysis of perioperative ketorolac and postoperative bleeding in reduction mammoplasty

Retrospective analysis of perioperative ketorolac and postoperative bleeding in reduction mammoplasty

Incidence of bleeding in children undergoing circumcision with ketorolac administration

Tonsillectomies, ketorolac, and the march of progress

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