Is it safe to administer Toradol (ketorolac) postoperatively?

From the Guidelines

Yes, it is safe to administer Toradol (ketorolac) postoperatively, as long as there are no contraindications, such as renal hypoperfusion or a history of atherothrombosis 1.

Benefits of Ketorolac

• Ketorolac has been shown to be effective in reducing postoperative pain and opioid requirements in various surgical procedures, including orthopedic, abdominal, and ureteroneocystectomy procedures 1.
• It can also decrease hospitalization costs and length of hospital stay 1.
• Ketorolac can be used in combination with other analgesics, such as morphine, to improve pain control and reduce opioid consumption 1.

Precautions and Contraindications

• Care should be taken when using ketorolac in patients with marginal kidney function, as it can be associated with acute kidney injury 1.
• Ketorolac should not be used in patients with a history of atherothrombosis, such as peripheral artery disease, stroke, or myocardial infarction, for more than 7 days 1.
• The use of ketorolac should be avoided in patients with renal hypoperfusion, and an estimated clearance of plasma creatinine below 50 mL/min is a contraindication to NSAID use 1.

Clinical Evidence

• Studies have shown that ketorolac can be safely used in various surgical procedures, including laparoscopic prostatectomy 1, open liver resection 1, and video-assisted thoracoscopic surgery 1.
• Ketorolac has been compared to other analgesics, such as paracetamol, and has been shown to have similar efficacy in reducing postoperative pain and opioid consumption 1.

From the FDA Drug Label

In postmarketing experience, postoperative hematomas and other signs of wound bleeding have been reported in association with the peri-operative use of IV or IM dosing of ketorolac tromethamine. Therefore, peri-operative use of ketorolac tromethamine should be avoided and postoperative use be undertaken with caution when hemostasis is critical

The administration of Toradol (ketorolac) postoperatively is not entirely safe and should be undertaken with caution. The risk of postoperative bleeding and hematomas is a concern, particularly when hemostasis is critical. It is recommended to avoid peri-operative use and use the lowest effective dose for the shortest possible duration if postoperative use is necessary 2. Key considerations include:

• Bleeding risk: increased risk of postoperative bleeding and hematomas
• Hemostasis: caution is necessary when hemostasis is critical
• Dose and duration: use the lowest effective dose for the shortest possible duration
• Patient monitoring: closely monitor patients for signs of bleeding or other adverse events.

From the Research

Safety of Administering Toradol (Ketorolac) Postoperatively

• The safety of administering Toradol (ketorolac) postoperatively has been evaluated in several studies 3, 4, 5, 6, 7.
• A meta-analysis of 27 double-blind, randomized, controlled studies found that postoperative bleeding occurred in 2.5% of patients in the ketorolac group compared with 2.1% in the control group, with no significant difference between the groups 3.
• Another study reviewed the supporting data from clinical studies addressing the safety of ketorolac use for postoperative pain and found that ketorolac in normal doses has been demonstrated to be safe with respect to bone healing, and in patients with normal kidney function, numerous studies have established the safety of ketorolac 4.
• A Cochrane review of 12 studies involving 1905 participants found that ketorolac probably results in a slight increase in total adverse event rates compared with placebo, but serious adverse events were rare 5.
• However, a case report described two catastrophic, near-fatal, hemorrhagic postoperative events attributed to single-dose parenteral ketorolac-induced coagulopathy, highlighting the potential risks of ketorolac use 6.
• In children, ketorolac has been shown to be effective for postoperative pain management, with a relatively low incidence of adverse effects, and is not associated with increased bleeding for most types of pediatric surgery 7.

Adverse Effects and Contraindications

• The most common adverse effects of ketorolac include increased bleeding time, gastrointestinal upset, and renal dysfunction 3, 4, 5.
• Ketorolac is contraindicated in patients with active peptic ulcer disease, renal impairment, and bleeding disorders 4, 6.
• The use of ketorolac should be carefully considered in patients with comorbid kidney, heart, and liver disease, as well as in elderly patients and those undergoing cardiovascular surgery 4, 5.

Dosage and Administration

• The recommended dosage of ketorolac varies depending on the patient population and the route of administration 5, 7.
• In adults, the typical dosage is 30 mg intravenously or intramuscularly every 6 hours, with a maximum daily dosage of 120 mg 5.
• In children, the recommended dosage is 0.5 mg/kg intravenously, followed by 1.0 mg/kg every 6 hours, with a maximum daily dosage of 90 mg 7.