title: Ketorolac after free tissue transfer: a comparative effectiveness study.
abstract: OBJECTIVE
  We sought to compare postoperative pain and complications in patients undergoing free tissue transfer for reconstruction of head and neck defects with and without ketorolac.
  
  
  METHODS
  In this retrospective cohort study, we identified patients who underwent head and neck free tissue transfer procedures at the University of Iowa between July 2010 and December 2012. A subset of patients received ketorolac as an anti-platelet agent. Main outcome measures include postoperative analgesic use, pain scores, and bleeding complications.
  
  
  RESULTS
  We identified 138 free tissue transfers, with 42 procedures in the ketorolac cohort. In the first 7 postoperative days, patients in the ketorolac and non-ketorolac cohorts received equivalent narcotic doses (morphine equivalents, 48.9 mg/day vs 46.6 mg/day, P = .72). The ketorolac group reported higher mean pain scores (3.1 vs 2.4, P = .004). Ketorolac use was not associated with need for transfusion (P = .86) or number of days with neck drains (P = .79).
  
  
  CONCLUSIONS
  Ketorolac did not demonstrate a significant analgesic effect in this group of patients in terms of pain scores and opioid requirements. However, there also was no evidence to suggest a higher likelihood of bleeding complications. Ketorolac may be safely used as an anti-platelet agent, with narcotic requirements unchanged.
authors.forename: J Robert
authors.initials: JR
authors.lastname: Schleiffarth
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Bayon
authors.forename: Kristi E
authors.initials: KE
authors.lastname: Chang
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Van Daele
authors.forename: Nitin A
authors.initials: NA
authors.lastname: Pagedar
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D016025:Bone Transplantation; D057186:Comparative Effectiveness Research; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D020910:Ketorolac / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D016378:Tissue Transplantation / Q000009:adverse effects*
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin; D020910:Ketorolac