title: Is ketorolac safe to use in plastic surgery? A critical review.
abstract: BACKGROUND
  Ketorolac tromethamine is a nonsteroidal anti-inflammatory drug (NSAID) that provides postoperative pain control and reduces narcotic requirements. However, concerns regarding postoperative hematoma have limited its use in plastic surgery.
  
  
  OBJECTIVE
  Our goal is to critically review the risk of bleeding with ketorolac in plastic surgery patients, with a focus on aesthetic surgery.
  
  
  METHODS
  A PubMed/Medline literature search of clinical trials using the keywords "surgery" and "NSAID" yielded 2574 results. Of these results, 1036 included ketorolac and twelve involved plastic surgery patients. Six studies reported postoperative hematoma rates: three prospective randomized trials, two retrospective reviews, and one case series. These were subjected to statistical analysis to determine if an association existed between ketorolac and postoperative hematomas.
  
  
  RESULTS
  Six papers reported 981 cases. Ketorolac use resulted in similar hematoma rates when compared to control groups, 2.5% (12 of 483) versus 2.4% (12 of 498), respectively (P = .79). There were no reported hematomas associated with ketorolac in over 115 patients undergoing aesthetic facial procedures. Hematoma rates of those undergoing aesthetic breast surgery, including reduction and augmentation mammoplasties, were 4.3% (11 of 257) in the ketorolac group versus 2.2% (6 of 277) in controls (P = .59). Reduction in postoperative narcotic use and improved pain scores was also reported.
  
  
  CONCLUSIONS
  Our literature review did not find a significant association between hematoma formation and ketorolac use in a variety of plastic surgery procedures. These findings are similar to those in other surgical subspecialties.
authors.affiliation: Dr Stephens is a Resident and Dr Langstein is the Chairman, Division of Plastic Surgery, University of Rochester Medical Center, Rochester, New York. Drs Richards and Schleicher are Aesthetic Fellows, and Dr Zins is the Chairman, Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Diana M
authors.initials: DM
authors.lastname: Stephens
authors.affiliation: Dr Stephens is a Resident and Dr Langstein is the Chairman, Division of Plastic Surgery, University of Rochester Medical Center, Rochester, New York. Drs Richards and Schleicher are Aesthetic Fellows, and Dr Zins is the Chairman, Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Bryson G
authors.initials: BG
authors.lastname: Richards
authors.affiliation: Dr Stephens is a Resident and Dr Langstein is the Chairman, Division of Plastic Surgery, University of Rochester Medical Center, Rochester, New York. Drs Richards and Schleicher are Aesthetic Fellows, and Dr Zins is the Chairman, Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: William F
authors.initials: WF
authors.lastname: Schleicher
authors.affiliation: Dr Stephens is a Resident and Dr Langstein is the Chairman, Division of Plastic Surgery, University of Rochester Medical Center, Rochester, New York. Drs Richards and Schleicher are Aesthetic Fellows, and Dr Zins is the Chairman, Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: James E
authors.initials: JE
authors.lastname: Zins
authors.affiliation: Dr Stephens is a Resident and Dr Langstein is the Chairman, Division of Plastic Surgery, University of Rochester Medical Center, Rochester, New York. Drs Richards and Schleicher are Aesthetic Fellows, and Dr Zins is the Chairman, Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Howard N
authors.initials: HN
authors.lastname: Langstein
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D006406:Hematoma / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D020911:Ketorolac Tromethamine / Q000009:adverse effects / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D020911:Ketorolac Tromethamine