Background: Ketorolac use has significantly expanded for postoperative pain management
since it first became available in the United States, primarily due to well established effects on patient
pain scores and its ability to reduce perioperative opioid requirements. As an inhibitor of cyclooxygenase,
ketorolac use has raised clinical concern including particular controversy regarding its potential effects on
bone healing, postoperative kidney function and perioperative bleeding.
Objective: To review the supporting data from clinical studies addressing the safety of ketorolac use for
Method: This review highlights the most up-to-date research from clinical trials as well as from retrospective
studies and meta-analyses regarding the effects of perioperative use of ketorolac on bone healing,
kidney function and blood loss.
Results: Based on the most up-to-date literature, ketorolac in normal doses has been demonstrated to be
safe with respect to bone healing. In patients with normal kidney function, numerous studies have established
the safety of Ketorolac; however other studies have raised safety concerns in patients with comorbid
kidney, heart and liver disease. While there is evidence that ketorolac may cause prolonged bleeding
time and may be associated with increased postoperative blood loss after tonsillectomy, large scale prospective
randomized controlled trials and subsequent meta-analyses have failed to establish an association
of ketorolac use and perioperative blood loss.
Conclusion: Perioperative administration of ketorolac has been demonstrated to be safe and effective in
healthy patients and is particularly beneficial as an opioid-sparing agent in vulnerable patient groups.
However, in certain surgical and medical contexts, proper patient selection based on the multidisciplinary
collaboration between perioperative clinician specialists will optimize patient safety and pain management