Intraoperative Ketorolac Reduces Narcotic Use In Breast Reduction And Outpatient Reconstruction Surgeries: A Double Blinded Prospective Randomized Controlled Trial
Joowon Choi, BA, MBS, MD, Andrew Tranmer, MD, Matthew Applebaum, MD, Brian Cripe, MD, Matthew Joy, MD, Anthony Capito, MD, Kurtis Moyer, MD, James Thompson, II, MD.
Carilion Clinic, Roanoke, VA, USA.
PURPOSE: Use of non-narcotic analgesics, such as ketorolac, has been shown to reduce post-operative pain and opioid consumption. Our objective is to analyze the safety and efficacy of ketorolac in outpatient breast procedures in a double-blinded randomized trial. We posit that intraoperative ketorolac will reduce post-operative narcotic use without increasing hematoma formation.
METHODS: Adult patients undergoing outpatient breast surgery were randomized to receive 15mg ketorolac, 30mg ketorolac, or saline placebo. Hematoma formation was assessed before discharge and at the first post-operative appointment. Patients recorded pain scores using a 11-pt Likert scale and opioid consumption for an average of 9 days.
RESULTS: 63 patients completed the study. Patients who received 30mg ketorolac had the fastest pain resolution as compared to the 15mg and placebo group (p<.05). Rate of opioid usage after discharge was also lowest in the 30mg group and was statistically lower than patients in the placebo group (p=0.02). Total opioid usage in PACU was not statistically different across the groups. Rate of opioid discontinuance was fastest overall in patients who received 15mg of ketorolac (rate=-0.072), as compared to the 30mg ketorolac group (rate=-0.071) and placebo group (rate=-0.065).
CONCLUSION: This study demonstrates that intraoperative ketorolac was associated with reduced opioid usage and post-operative pain, without an increase in hematoma formation. However, due to the study size, the difference in hematoma rate was not statistically significant.
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