Perioperative Ketorolac and Postoperative Hematoma Formation in Adolescent Reduction Mammaplasty: A Single Surgeon Experience of 500 Consecutive Cases
Joseph M. Firriolo, MD, Laura C. Nuzzi, BA, Lauren C. Schmidtberg, PA-C, MMSc, Brian I. Labow, MD.
Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
PURPOSE: The opioid crisis is a growing public health concern in the United States. Correspondingly, pain control is increasingly focused on minimizing the use of opioid medications in the perioperative period. Ketorolac is proven to help manage postoperative pain and decrease the amount of required opioids; however its use is limited due to concerns of postoperative bleeding and hematoma formation. This study explores the relationship between hematoma formation and administration of perioperative ketorolac in adolescent females undergoing reduction mammaplasty.
METHODS: We reviewed the records of 500 consecutive patients who underwent reduction mammaplasty.
RESULTS: Five-hundred patients were included in our analyses. The average age at the time of operation was 18.0 ± 2.2 years. 389 (77.8%) patients received intravenous ketorolac in the perioperative period. Seven (1.4%) patients developed a postoperative hematoma: three were drained under local anesthesia, and four underwent surgical drainage in the operating room. Hematoma was not associated with intraoperative ketorolac use (p=0.999), postoperative ketorolac use (p=0.432), or any perioperative ketorolac use (p=0.654). The mean age, total resection mass, and intraoperative/postoperative ketorolac dose of patients did not significantly differ by hematoma status (p>0.05, all). Intraoperative use of ketorolac was associated with lower total dosing of intraoperative fentanyl (p<0.001) and morphine (p=0.009). Postoperative use of ketorolac was associated with lower total dosing of postoperative morphine (p<0.001).
CONCLUSION: Ketorolac use in our patient sample was associated with decreased perioperative opioid use, but not with hematoma formation. Ketorolac may be safe to use in adolescent reduction mammaplasty without increasing the risk of hematoma formation.
Back to 2018 Program