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Routine Ketorolac Use for Postoperative Pain Does Not Increase Bleeding Risk After Hysterectomy.

Grace M Pipes1, Rebecca J Schneyer2, Kacey M Hamilton2

  • 1Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.

Journal of Clinical Medicine
|January 28, 2026
PubMed
Summary
This summary is machine-generated.

Ketorolac is safe for pain control after hysterectomy and does not increase bleeding risk. This non-steroidal anti-inflammatory drug can be used as an opioid-sparing option for postoperative pain management.

Keywords:
Minimally Invasive Gynecologic Surgerybleeding complicationshysterectomyketorolacpain managementpostoperative

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Area of Science:

  • Obstetrics and Gynecology
  • Anesthesiology
  • Surgical Outcomes Research

Background:

  • Ketorolac is an effective analgesic but carries a potential risk of perioperative bleeding.
  • The bleeding risk of ketorolac in hysterectomy patients has not been previously evaluated.
  • This study addresses the safety of ketorolac in gynecologic surgery, specifically hysterectomy.

Purpose of the Study:

  • To assess the risk of postoperative bleeding complications associated with ketorolac administration following hysterectomy.
  • To determine if ketorolac use increases the likelihood of transfusion, readmission, or reoperation for bleeding after hysterectomy.
  • To evaluate ketorolac's safety as an opioid-sparing agent in the context of hysterectomy.

Main Methods:

  • Retrospective cohort study of 4236 patients undergoing hysterectomy for benign indications (2015-2024).
  • Analysis included multivariable regression to adjust for factors like age, ASA category, celecoxib use, anticoagulation, uterus size, surgical approach, complexity, and lysis of adhesions.
  • Primary outcome: composite of postoperative bleeding complications (transfusion, readmission, reoperation).

Main Results:

  • 76% of patients received postoperative ketorolac.
  • The composite bleeding rate was lower in the ketorolac group (2.1% vs. 4.1%, p=0.001).
  • Multivariable analysis showed no association between ketorolac use and increased bleeding risk (aOR 1.02). Major perioperative complications and ileus were less likely with ketorolac.

Conclusions:

  • Ketorolac administration is not associated with an increased risk of bleeding complications after hysterectomy.
  • Ketorolac can be safely used as an opioid-sparing analgesic in patients undergoing hysterectomy.
  • Findings support the use of ketorolac even when celecoxib is used preoperatively in enhanced recovery protocols.