Does Ketorolac increase the risk of bleeding in patient undergoing circumcision? Retrospective review.
Carolina Fermin-Risso, Paediatric Urologist1, Bruce Gao, Undergraduate Medicine, The University of Calgary2, Premal Patel, Department of Surgery, University of Manitoba3, Adrian Frusescu, Undergraduate Nursing, The University of Calgary2, Taylor Remondini, Undergraduate Medicine, The University of Calgary2, Navraj Dhaliwal, Undergraduate Medicine, The University of Calgary2, Anthony Cook, Paediatric Urologist1, Bryce Weber, Paediatric Urologist1.
1Alberta Children's Hospital, Calgary, AB, Canada, 2The University of Calgary, Calgary, AB, Canada, 3University of Manitoba, Manitoba, MB, Canada.
Circumcision is the most common surgical procedure performed by pediatric urologists. The control of post-operative pain is essential in order to decrease patient morbidity and to improve patient and parent satisfaction. Ketorolac has been shown to have an efficacy similar to morphine in multi-modal analgesic regimens without the commonly associated adverse effects. Concerns with peri-operative bleeding limit the use of ketorolac as an adjunct for pain control in surgical patients. As such, we sought to evaluate our institutional outcomes with respect to ketorolac and post-operative bleeding. We retrospectively reviewed all pediatric patients undergoing circumcision from January 1st, 2014 to December 31st, 2015 at the Alberta Children's Hospital. Demographics, peri-operative analgesic regimens, and return to emergency department or clinic for bleeding were gathered through chart review. 475 patients undergoing circumcisions were studied at the Alberta Children's Hospital, including 150 (32%) who received peri-operative ketorolac and 325 (68%) who received standard analgesia. Patients receiving ketorolac were more likely to return to the emergency department or clinic for bleeding (ketorolac group - 19/150, 11%, non-ketorolac group - 16/325, 3.3%, p = 0.005). Patients receiving ketorolac were more likely to have post-operative sanguineous drainage (ketorolac group - 96/150, 64.0%, non-ketorolac group - 150/325, 46.2%, p <0.001). There was no significant difference in the number of patients requiring post-operative admission or further medical intervention. Although a promising analgesic, ketorolac requires additional investigation for safe usage in circumcisions due to possible increased risk of bleeding.
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