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Bleeding risk with ketorolac after lumbar microdiscectomy
Kingsley R Chin1, Hariharan Sundram, Paul Marcotte
1Spine Surgery Service, Department of Orthopaedics, University of Pennsylvania Medical School, Philadelphia, PA 19104, USA. kingsleychin@hotmail.com
Abstract:
There is a need to improve postoperative analgesia to support the trend to shorter hospitalization after minimally invasive spine surgeries. Ketorolac Tromethamine has proven efficacy in decreasing postoperative pain but there is concern with postoperative epidural bleeding after spine procedures. We prospectively assessed the incidence of bleeding complications after microdiscectomy in patients treated with a single 30 mg intraoperative dose of Ketorolac subsequent to wound closure. Group 1 consisted of 44 patients, 24 women and 20 men with mean age of 35.7 years (20 to 68 y) treated with Ketorolac. Group 2 consisted of 45 patients, 28 men and 17 women with mean age 46.8 years (32 to 74 y), who underwent discectomy without Ketorolac. Postoperative bleeding complications were monitored along with pain levels and time to discharge. We detected no significant postoperative changes in coagulation parameters or bleeding from the surgical site in either group. Both group 1 and 2 had averaged preoperative visual analog scale scores for leg pain of 8. Group 1 had an average postoperative visual analog scale score of 2.6 compared with 4 for group 2 two hours after surgery. Single dose intravenous Ketorolac provided beneficial analgesia without significant increase in risk of bleeding after microdiscectomy, enabling us to consistently perform microdiscectomy as an ambulatory procedure. Meticulous hemostasis should be accomplished before closure. Prolonged postoperative use is a promising alternative to narcotics.
Insights
A single dose of Ketorolac Tromethamine effectively reduced postoperative pain after microdiscectomy without increasing bleeding risks. This nonsteroidal anti-inflammatory drug supports same-day discharge for minimally invasive spine surgery patients.
Area of Science:
- Neurosurgery
- Anesthesiology
- Orthopedics
Background:
- Minimally invasive spine surgeries aim for shorter hospital stays, necessitating improved postoperative pain management.
- Ketorolac Tromethamine is effective for pain relief but raises concerns about postoperative bleeding in spinal procedures.
Purpose of the Study:
- To assess the safety and efficacy of a single intraoperative dose of Ketorolac Tromethamine in reducing postoperative pain after microdiscectomy.
- To evaluate the incidence of bleeding complications in patients receiving Ketorolac Tromethamine compared to a control group.
Main Methods:
- Prospective study of 44 patients receiving a single 30 mg intraoperative dose of Ketorolac Tromethamine post-wound closure.
- A control group of 45 patients underwent microdiscectomy without Ketorolac Tromethamine.
- Monitoring of postoperative bleeding, coagulation parameters, pain levels (Visual Analog Scale), and time to discharge.
Main Results:
- No significant differences in postoperative coagulation parameters or surgical site bleeding were observed between the Ketorolac and control groups.
- Patients receiving Ketorolac Tromethamine reported lower average postoperative Visual Analog Scale scores for leg pain (2.6) compared to the control group (4) two hours after surgery.
- The study supported ambulatory surgery for microdiscectomy procedures.
Conclusions:
- A single intraoperative dose of Ketorolac Tromethamine provides effective analgesia after microdiscectomy with no significant increase in bleeding risk.
- Meticulous surgical hemostasis remains crucial before wound closure.
- Extended postoperative use of Ketorolac Tromethamine presents a viable alternative to opioid analgesics.