title: Subcapsular hematoma after laparoscopic cholecystectomy, associated with ketorolac administration.
abstract: Ketorolac is the first injectable nonsteroidal antiinflammatory drug used as an analgesic in the perioperative period. Its adverse effect profile is different from that of the opioid analgesics; in particular, in its lack of respiratory depressive actions. However, ketorolac has risks associated with its perioperative administration, including episodes of substantial gastrointestinal bleeding. A patient undergoing elective laparoscopic cholecystectomy developed a subcapsular hepatic hematoma shortly after receiving a dose of injectable ketorolac. No evidence of parenchymal injury was found on laparoscopy, which argues against iatrogenic trauma. Clinicians should be aware that ketorolac may cause or aggravate bleeding, and it should be used with caution in perioperative patients.
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy, University of Arizona, Tucson 85721.
authors.forename: B L
authors.initials: BL
authors.lastname: Erstad
authors.forename: W D
authors.initials: WD
authors.lastname: Rappaport
mesh_terms: D000328:Adult; D000700:Analgesics / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D006406:Hematoma / Q000139:chemically induced*; D006801:Humans; D020910:Ketorolac; D011183:Postoperative Complications / Q000139:chemically induced*; D014046:Tolmetin / Q000009:adverse effects / Q000031:analogs & derivatives*; D014057:Tomography, X-Ray Computed
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D014046:Tolmetin; D020910:Ketorolac