title: Ketorolac tromethamine and hemorrhage in tonsillectomy: a prospective, randomized, double-blind study.
abstract: Ketorolac tromethamine (KT) is a nonsteroidal, antiinflammatory analgesic. Its nonsedating property makes it an attractive analgesic for sleep apnea patients undergoing uvulopharyngopalatoplasty, but its antiplatelet activity makes the potential for postoperative hemorrhage a concern. A prospective, randomized, double-blind study was designed to evaluate the bleeding risk of KT using adult tonsillectomy patients as the model. Patients were randomized into two groups receiving Meperidine (MP) (controls) or KT for the first postoperative day. Posttonsillectomy bleeding rates of 7% (3/43) in the MP group and 18.9% (7/37) in the KT group were demonstrated, but this difference was not statistically significant. The number of KT doses administered had no effect on the incidence of bleeding or the number of cases requiring return to the operative suite for hemostasis. Although this study did not attain statistical significance, the trend towards increased hemorrhage with KT is worrisome. This study and other reports in the literature support the manufacturer's warning that the use of KT is contraindicated in major surgery.
authors.affiliation: Otolaryngology Service, Womack Army Medical Center, Fort Bragg, North Carolina, USA.
authors.forename: R
authors.initials: R
authors.lastname: Bailey
authors.forename: C
authors.initials: C
authors.lastname: Sinha
authors.forename: L P
authors.initials: LP
authors.lastname: Burgess
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D004311:Double-Blind Method; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D020911:Ketorolac Tromethamine; D008614:Meperidine / Q000627:therapeutic use; D011183:Postoperative Complications / Q000139:chemically induced*; D011446:Prospective Studies; D014046:Tolmetin / Q000009:adverse effects / Q000031:analogs & derivatives*; D014068:Tonsillectomy; D014325:Tromethamine / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D014325:Tromethamine; D020911:Ketorolac Tromethamine; D008614:Meperidine; D014046:Tolmetin