Ketorolac use and postoperative complications in colorectal surgery

Abstract

ObjectiveTo determine if use of intravenous ketorolac in the perioperative period for colorectal surgeries is associated with higher rates of reinterventions, emergency-department (ED) visits, and readmissions.BackgroundInjectable NSAIDs, such as ketorolac, have been shown to have an equivalent analgesic effect to morphine in major abdominal surgery and reduce the use of opioid medications. However, NSAIDs have corresponding adverse reactions, mainly on the gastrointestinal tract, and cardiovascular, liver, and kidney injury.Patients and methodsA clinical trial study was carried out on 50 adult patients who had undergone colorectal surgery in General Surgery Department in Menoufia University and Damanhur Medical National Institute, that aimed to determine if use of intravenous ketorolac in the perioperative period for colorectal surgeries is associated with higher rates of reinterventions, ED visits, and readmissions during the period from March 2019 to March 2021.ResultsType of operation, duration of operation, and first bowel motion showed significant differences between patients with and without ketorolac in the first bowel motion. While no significant difference was found between both groups regarding outcome. The ketorolac group was associated with higher ED visits (K: 16% vs. no K: 12%), higher rates of readmission (K: 12% vs. no K: 8%), and equal rates of reintervention (K: 4% vs. no K: 4%) with no statistically significant differences between patients with and without ketorolac. However, rates of anastomotic leakage in relation to use of ketorolac during the postoperative period for the ketorolac group show that 4% used ketorolac for 3–5 days and 8% used ketorolac for more than 5 days, it shows statistically significant rates of anastomotic leakage with longer duration of ketorolac use.ConclusionKetorolac as one of the most commonly used NSAIDS was not associated with anastomotic leak or other important postoperative outcomes, however, overuse of ketorolac over a long period may lead to increased rates of anastomotic leakage or postoperative bleeding. Recognizing the significant benefit of ketorolac, its appropriate use in the postoperative period appears safe.