From the Guidelines
Toradol (ketorolac) should not be administered to patients post quad bypass surgery due to significant safety concerns, including increased risk of bleeding complications and acute kidney injury. The use of ketorolac in patients with marginal kidney function is also associated with acute kidney injury, as noted in a study published in JAMA Surgery 1. Although this study focused on children and adolescents after surgery, the concerns about kidney function and bleeding risks are relevant to adult patients post quad bypass surgery as well. In the context of postoperative pain management for patients after coronary artery bypass graft (CABG) surgery, it is crucial to prioritize alternatives that minimize risks of bleeding, kidney injury, and cardiovascular complications. Some key considerations for post-CABG pain management include:
- Opioid analgesics
- Acetaminophen
- Gabapentinoids These alternatives are generally safer and can be used to effectively manage pain while minimizing the risks associated with NSAIDs like ketorolac. It's also important to note that if an NSAID is deemed necessary, it should only be used after careful risk assessment, at the lowest effective dose, for the shortest duration possible, and with close monitoring of renal function, bleeding parameters, and cardiovascular status.
From the FDA Drug Label
Ketorolac tromethamine is CONTRAINDICATED in the setting of coronary artery bypass graft (CABG) surgery The administration of IM Toradol (Ketorolac) to someone who’s had quad bypass surgery is contraindicated due to the increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal 2.
From the Research
Administration of Toradol (Ketorolac) Post Quad Bypass Surgery
- The safety of administering Toradol (Ketorolac) to patients post quad bypass surgery is a concern due to potential adverse effects such as gastrointestinal bleeding, platelet inhibition, and renal impairment 3.
- A study published in 2014 found that ketorolac appears to be well-tolerated for use when administered selectively after cardiac surgery, with similar or better postoperative outcomes compared to patients who did not receive ketorolac 4.
- However, the same study notes that a black box warning exists for the use of NSAIDs, including ketorolac, after cardiac surgery, and further research is needed to fully understand its perioperative administration 4.
- Another study published in 1997 found that the risk of acute renal failure associated with ketorolac is similar to that of opioids when used for 5 days or less, but may be elevated when used for more than 5 days 5.
- It is essential to carefully select patients and follow label warnings and dosage guidelines when considering the use of ketorolac post quad bypass surgery 3.
Key Considerations
- Patients who have undergone quad bypass surgery should be carefully evaluated for potential contraindications to ketorolac use, such as a history of gastrointestinal bleeding or renal impairment 3.
- The dosage and duration of ketorolac therapy should be limited to the lowest necessary to control pain and as few days as possible 3.
- Close monitoring of patients for potential adverse effects, such as gastrointestinal bleeding and renal impairment, is crucial when administering ketorolac post quad bypass surgery 3, 4, 5.