From the FDA Drug Label
To minimize the potential risk for an adverse GI event, the lowest effective dose should be used for the shortest possible duration Patients and physicians should remain alert for signs and symptoms of GI ulceration and bleeding during NSAID therapy and promptly initiate additional evaluation and treatment if a serious GI adverse event is suspected. For high risk patients, alternate therapies that do not involve NSAIDs should be considered.
Ketorolac (Toradol) Use After Gastric Sleeve Procedure:
- The FDA drug label does not provide direct information on the use of ketorolac after a gastric sleeve procedure.
- However, considering the increased risk of GI complications with NSAID use, especially in patients with a history of GI problems or those at high risk for GI bleeding, caution is advised.
- Given the potential risks, alternative therapies that do not involve NSAIDs should be considered for patients after a gastric sleeve procedure, especially if they are at high risk for GI complications 1.
- If ketorolac is considered necessary, close monitoring for signs and symptoms of GI ulceration and bleeding is recommended 1.
From the Research
Taking Toradol (ketorolac) after gastric sleeve surgery is not recommended due to the potential risk of gastrointestinal complications, but if necessary, it should be used with caution and under medical supervision, as evidenced by a study published in 2022 2. When considering pain management after gastric sleeve surgery, it's essential to weigh the risks and benefits of using Toradol, a potent NSAID that can irritate the stomach lining and potentially cause ulcers or bleeding.
- The study published in 2022 2 found no association between NSAID exposure and the development of peptic ulcers after sleeve gastrectomy, suggesting that temporary use of NSAIDs like Toradol may be safe in this patient population.
- However, another study published in 2021 3 reported a high rate of NSAID use after sleeve gastrectomy, with 64.5% of respondents reporting some NSAID use, and no cases of sleeve complications secondary to NSAID use were identified.
- A systematic review published in 2019 4 found limited evidence to recommend an optimal analgesic regimen for laparoscopic sleeve gastrectomy, but suggested that acetaminophen and a non-steroidal anti-inflammatory drug, with opioids as rescue analgesics, may be a pragmatic approach.
- Older studies, such as one published in 1995 5, reported cases of gastrointestinal complications associated with intramuscular ketorolac tromethamine therapy in elderly patients, highlighting the need for caution when using Toradol in vulnerable populations.
- A more recent study published in 2024 6 focused on the management of gastroesophageal reflux disease after sleeve gastrectomy, but did not specifically address the use of Toradol in this context. Overall, while the evidence suggests that Toradol may be used cautiously in patients after gastric sleeve surgery, it's crucial to prioritize alternative pain management strategies, such as acetaminophen or carefully monitored opioids, to minimize the risk of gastrointestinal complications.