Routine perioperative ketorolac administration is not associated with hemorrhage in pediatric neurosurgery patients
Richardson, Palmeri, Williams et al. (JNS)
Retrospective review of 2657 consecutive cases and 1593 patients at Children’s Hospital Colorado from 2006 to 2012. After exclusion criteria (recent hemorrhage or high risk of hemorrhage), 1451 procedures comprised the study sample. Procedures were stratified into 5 different categories (Type 1: Intradural craniotomy/craniectomy except Chiari I malformation, Type 2: Intradural catheter/endoscope placement, Type 3: Extradural craniotomy/craniectomy + Chiari I malformation, Type 4: Spinal procedure, Type 5: Minor procedure (e.g., EVD, intracranial pressure monitor). Exposure was considered if the patients received 1 dose of ketorolac within 72 hours of their neurosurgical procedure. Outcomes measured were clinically significant hemorrhage, radiographic evidence of hemorrhage, or renal/GI complications related to ketorolac. Ketorolac was administered in 65.8% of cases. 2 patients developed GI tract ulceration and 2 patients developed renal failure. These events were not felt by the authors to be specifically related to the ketorlac. 7 patients developed clinically significant (requiring reoperation) hematomas. 4 of the patients received ketorolac perioperatively while 3 did not, suggesting no statistically significant difference. The authors claim that there is no association between ketorolac use and clinically or radiographically significant hemorrhage.
Abstract link: http://thejns.org/doi/full/10.3171/2015.4.PEDS14411