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Scheduled Postoperative Ketorolac Does Not Decrease Opiate Use following Free Flap Breast Reconstruction.

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Postoperative ketorolac did not significantly reduce opioid use in breast reconstruction patients. Surgeons should evaluate its effectiveness for reducing opioid consumption in enhanced recovery protocols.

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Area of Science:

  • Plastic Surgery
  • Pain Management
  • Pharmacology

Background:

  • Managing postoperative pain without opioids is a growing concern due to the opioid crisis.
  • Enhanced recovery after surgery (ERAS) protocols aim to reduce complications, costs, and opioid use.
  • Ketorolac is frequently included in ERAS protocols, but its independent impact is understudied.

Purpose of the Study:

  • To evaluate the independent effect of postoperative ketorolac on opioid utilization and complications in autologous breast reconstruction.
  • To compare outcomes between patients receiving and not receiving scheduled postoperative ketorolac.

Main Methods:

  • Retrospective chart review of 110 patients undergoing autologous breast reconstruction.
  • Comparison of patients who received postoperative ketorolac versus those who did not.
  • Analysis of demographics, reconstruction details, length of stay, complications, reoperations, and morphine milligram equivalents (MMEs).

Main Results:

  • No significant difference in postoperative complication rates between groups (12.7% in both).
  • Mean postoperative MMEs were similar: 344.7 (no ketorolac) vs. 336.5 (ketorolac).
  • Ketorolac was not independently associated with reduced opioid use or increased complications.

Conclusions:

  • Scheduled postoperative ketorolac did not significantly decrease opioid use in this cohort.
  • Surgeons should critically assess ketorolac's role in reducing postoperative opioid requirements in free flap breast reconstruction.