Abstract
Objective: 1) Describe the effect on postoperative pain and narcotic requirements in patients receiving ketorolac as an antiplatelet agent after head and neck free tissue transfer. 2) Assess for bleeding complications in patients receiving ketorolac.
Method: We identified patients who underwent head and neck free tissue transfer procedures at the University of Iowa between July 2010 and December 2011. A subset of patients received ketorolac as an antiplatelet agent at the discretion of the attending surgeon. Postoperative analgesic use, pain scores, and bleeding complications were compared.
Results: We identified 88 free tissue transfers, with 25 procedures in the ketorolac cohort. Patients in the nonketorolac group received a higher dose of aspirin (198.7 mg/d vs 26.2 mg/d, P < .0001). In the first 10 postoperative days, patients in the ketorolac and nonketorolac cohorts received equivalent narcotic doses (morphine equivalents, 49.4 mg/d vs 44.4 mg/d, P = .45). The ketorolac group reported higher pain scores (2.9 vs 2.1, P = .002), still significant after correcting for the effect of bone flaps. Ketorolac use was not associated with need for transfusion (P = .66). Reexploration rates, length of hospitalization, and days with neck drains were not different.
Conclusion: Ketorolac did not demonstrate a significant analgesic effect in this group of patients. However, there also was no evidence to suggest a higher likelihood of bleeding complications or prolonged need for suction drains. Ketorolac may be safely used as an antiplatelet agent, with narcotic requirements unchanged.
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