Safety of Continuous Infusion Ketorolac in Postoperative Coronary Artery Bypass Graft Surgery Patients

Abstract

Background:Continuous infusion ketorolac is sometimes utilized for analgesia in postoperative coronary artery bypass graft (CABG) patients despite contraindications for use. Limited literature surrounds this topic; therefore, this study was conducted to evaluate the safety of this practice. Methods: This retrospective cohort study evaluated the primary outcome of mortality and secondary outcomes of incidence of bleeding and myocardial infarction (MI). All patients who underwent isolated CABG surgeries and received continuous infusion ketorolac during the study period were included. An equal number of randomly selected isolated CABG patients served as control patients. Electronic medical records and the Society of Thoracic Surgeons (STS) database were utilized to determine baseline characteristics and outcomes; Results: One hundred and seventy-eight patients met inclusion; 89 in each group. More patients in the control group underwent on-pump surgeries (78.6% vs. 29.2%, p = 0.01) and had higher STS risk scores (1.1% vs. 0.6%, p = 0.003). There was no difference in mortality between the ketorolac group and control group (2.2% vs. 3.3%, p = 0.605). Additionally, no patients experienced a MI and there was no difference in bleeding incidence (5.5% vs. 6.7%, p = 0.58); Conclusions: No association was found between continuous infusion ketorolac and increased risk of mortality, MI, or bleeding events in postoperative CABG patients. Considerations to differences in baseline characteristics must be made when interpreting results.

Comparing the effects of ketorolac and Paracetamol on postoperative pain relief after coronary artery bypass graft surgery. A randomized clinical trial

“…Also, it can reduce postoperative additional analgesic requirements in comparison to Paracetamol with no additional adverse effects. This finding was similar to Amini S et al study (20). Of course, their study was in congenital cardiac patients.…”

“…The patients in the ketorolac group were administered at a rate of 0.5 mg/kg IV admixed with 100 ml of normal saline each 6 h for 24 h. A bolus may be given at the start of therapy if desired. The patients in the Paracetamol group were given 10 mg/kg IV of Paracetamol (mixed with normal saline to a total volume of 100 ml) for 30 min each 6 h for 24 h. (Dose of ketorolac determined based on Howard et.al study [20]. Patients were extubated according to the following criteria: responsive and cooperative, pO2 of 80-100, oxygenation index of pO2/FiO2 > 300, and hemodynamic stability without any inotropes.…”

The Effect of Diclofenac on Bleeding, Platelet Function, and Consumption of Opioids Following Cardiac Surgery

“…In a pooled data analysis of two multicentre, randomized studies, De Souza et al did not identify an increased short-term risk of myocardial infarction, stroke, or increased mortality 30 days after cardiac surgery with the use of NSAIDs [22] . Howard et al [23] studied 178 patients treated for CABG. They compared the incidence of mortality, myocardial infarction, and bleeding among patients who received continuous infusion of 90 mg ketorolac and in the control group within 24 hours.…”

Comparing the Effects of Ketorolac and Paracetamol on Postoperative Pain relief after Coronary Artery Bypass Graft surgery. A randomized clinical trial

“…( Dose of ketorolac determined based on Howard et.al study. [20] Patients were extubated according to the following criteria: responsive and cooperative, pO2 of 80-100, oxygenation index of pO2/FiO2 > 300, and hemodynamic stability without any inotropes.…”