Posthysterectomy bleeding after ketorolac tromethamine and spinal anesthesia. A case report

Ketorolac is a very useful medication in gynecologic surgery, providing pain relief and less narcotic use. This greatly shortens the recovery time and length of hospital stay. As with other nonsteroidal antiinflammatories, gynecologists are aware of the potential for bleeding problems from ketorolac, yet those bleeding complications have rarely been seen in gynecology and have not been previously reported in the gynecologic literature. A recent case demonstrates the serious complication that can occur when ketorolac inhibits platelet function postoperatively.

A 36-year-old woman began bleeding intraabdominally shortly after an otherwise-unremarkable vaginal hysterectomy done under spinal anesthesia.

A literature review suggests that this complication is highly associated with nongeneral anesthesia surgery, such as spinal, epidural and conscious sedation. This fact, however, has not been published in the gynecologic literature and is not well known to gynecologists. Pending further elucidation of this problem, avoidance of ketorolac perioperatively with nongeneral anesthesia cases should be considered.