• Oculoplastics/Orbit

    Review of: Does intraoperative ketorolac increase bleeding in oculoplastic surgery?

    Chang M, Gould A, Gur Z, et al. Ophthalmic Plastic and Reconstructive Surgery, July/August 2020

    This retrospective study reviewed adverse postoperative bleeding outcomes in patients who received intravenous (IV) ketorolac during oculofacial surgical procedures.

    Study design

    The study included 11 patients who underwent lacrimal surgery requiring bony manipulation or orbital surgery at a single US academic medical center between 2016 and 2018. All surgeries were performed under general anesthesia by a single surgeon. Thirty-one of the 111 patients received 30 mg of IV ketorolac during surgery. The primary outcome was the presence of a postoperative major bleeding event, according to the International Society of Thrombosis and Haemostasis definition.


    No major bleeding events occurred in the patients who either did or did not receive intraoperative ketorolac. In addition, all patients had similar findings in terms of ecchymosis grade at 1 week following surgery and ecchymosis persisting 4 weeks after surgery.


    The use of intraoperative ketorolac is controversial in oculofacial surgery due to the perceived risk of postoperative bleeding. Interobserver variability is of concern, as 4 masked researchers independently evaluated frontal facial view photographs taken at the first and second postoperative visits. The degree of ecchymosis may be underestimated without 3-dimensional assessment and palpation. The sample size was also relatively small.

    Clinical significance

    Some studies have reported that ketorolac may be comparable to opioids in terms of its effective pain relief. As oculofacial surgeons have been historically taught that the use of a nonsteroidal anti-inflammatory drug could potentiate bleeding, in the wake of the ongoing opioid crisis surgeons should reconsider the use of ketorolac as a means of intraoperative and perhaps even postoperative analgesia.