The effects of ketorolac on microvascular thrombosis in lower extremity reconstruction.
BACKGROUND
Ketorolac is commonly prescribed for relieving postoperative pain and is known to have an anticoagulation effect, though this has not been studied in a clinical series. The aim of this study was to evaluate the effects of ketorolac on microvascular thrombosis in lower extremity reconstruction.


METHODS
A retrospective chart review was performed for patients who underwent lower limb reconstruction with a free flap between January of 2005 and September of 2011. Patients were categorized into two groups based on the administration of ketorolac for postoperative pain relief. Complications were assessed, and the two groups were compared for vascular insufficiency, total or partial flap loss, and hematoma formation.


RESULTS
A total of 128 patients underwent microsurgical flap transfer, including 111 thoracodorsal artery perforator flaps, four latissimus dorsi myocutaneous flaps, seven deep inferior epigastric artery perforator flaps, and six anterolateral thigh flaps. Eighty patients were administrated ketorolac, and 48 patients were not. The nonketorolac group had significantly higher rates of vascular-related complications, and the difference remained significant after adjusting for confounding factors on multivariate logistic regression analysis. There was a correlation between the duration of ketorolac administration and complication rates, for which longer periods of ketorolac administration yielded lower complication rates.


CONCLUSIONS
Ketorolac administration has a protective effect against the development of microvascular thrombosis and can be a preferred analgesic in free tissue transfer.


METHODS
Therapeutic, III.
Seoul, South Korea From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Kyeong Tae
KT
Lee
Byung-Joon
BJ
Jeon
So-Young
SY
Lim
Jai-Kyung
JK
Pyon
Sa-Ik
SI
Bang
Kap-Sung
KS
Oh
Goo-Hyun
GH
Mun
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006801:Humans; D007275:Injections, Intravenous; D020910:Ketorolac / Q000008:administration & dosage*; D035002:Lower Extremity / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D008866:Microsurgery / Q000009:adverse effects; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy; D011182:Postoperative Care / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult
D016861:Cyclooxygenase Inhibitors; D020910:Ketorolac