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Perioperative Ketorolac and Hematoma Following Breast Reduction: A Systematic Review and Meta-analysis
Victor F A Almeida1, Glaudir Donato2, Manoela Dantas3
1Department of Anesthesiology, Cleveland Clinic Foundation, Cleveland, Ohio, 44195, USA.
Background:
Ketorolac, a nonsteroidal anti-inflammatory drug, is a promising opioid-sparing option for postoperative pain control. However, its impact on platelet function raises concerns about bleeding risk. Reduction mammaplasty carries a known risk of hematoma, and this study aimed to assess whether perioperative ketorolac increases this risk.
Methods:
We searched Cochrane Central, Embase, PubMed, and Web of Science databases for studies involving breast reduction patients who did or did not receive perioperative ketorolac. The primary outcome was hematoma formation, with secondary outcomes distinguishing between cases requiring surgery and those managed conservatively. A random-effects model calculated pooled odds ratios (OR) with 95% confidence intervals (CI), and heterogeneity was assessed using the I2 statistic.
Results:
Seven studies involving 3,418 patients were included-1991 in the ketorolac group and 1427 in the control group. The hematoma incidence was 6.13% in the ketorolac group versus 6.73% in controls. Meta-analysis revealed a significantly increased risk of hematoma in ketorolac users (OR 2.63, 95% CI 1.58-4.37, p < 0.001, I2 = 37.5%), particularly in cases managed conservatively (OR 2.72, 95% CI 1.37-5.38, p = 0.004, I2 = 26.3%). Sensitivity analysis reinforced these findings, also demonstrating an association between ketorolac and hematomas requiring reoperation.
Conclusion:
Perioperative ketorolac is associated with an increased risk of hematoma following breast reduction surgery. While it provides effective opioid-sparing analgesia, its use should be carefully considered, especially in patients with higher bleeding risks. Further randomized trials are needed to refine safety recommendations.
Level Of Evidence Ii:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
