Incidence of hematoma associated with ketorolac after TRAM flap breast reconstruction

Ketorolac is frequently used as an adjunct for postoperative;pain relief, e specially by anesthesiologists during the immediate postoperative period. I t can be used alone as an analgesic but is more often used to potentiate th e actions of narcotics such as morphine or meperidine in an attempt to redu ce the total dose and side effects of those drugs. The manufacturer of keto rolac cautions against its use in patients who have a high risk of postoper ative bleeding, for fear of increasing the risk of hematoma, but the risk i n transverse rectus abdominis musculocutaneous (TRAM) flap patients has nev er been reported. In a study of 215 patients who had undergone TRAM flap br east reconstruction, it was determined that patients who received intraveno us ketorolac (n = 65) as an adjunct to their treatment with morphine admini stered by use of a patient-controlled analgesia device required less morphi ne (mean cumulative dose, 1.39 mg/kg) than did patients who did not receive ketorolac (n = 150; mean cumulative dose, 1.75 mg/kg; p = 0.02). There was no increase in the incidence of hematoma in patients who were treated with ketorolac. The data presented in this study suggest that the use of intrav enous ketorolac does reduce the need for narcotics administration in patien ts undergoing TRAM flap breast reconstruction, without significantly increa sing the risk of hematoma.