Ketorolac (Controversies)


  1. How robust is the pain control provided by ketorolac?
  2. Does ketorolac, administered in the perioperative period, increase the risk of renal failure?
  3. Does ketorolac increase the risk of postoperative bleeding?
  4. Does ketorolac inhibit bone healing in humans following orthopedic or neurological surgery?

Data on Renal Failure

Data Favoring Ketorolac: a multicenter, prospective, randomized, controlled trial of 11,245 patients compared ketorolac (90 mg/day for 2 days followed by oral 40 mg/day for up to 7 days) to diclofenac or ketoprofen in adults undergoing major, elective surgery. The overall risk of the following complications was noted – surgical site bleeding (1.04%), acute renal failure (0.09%), GI bleeding (0.04%), with no differences between ketorolac and ketoprofen or diclofenac.

Data on Postoperative Hemorrhage Risk

Data Against Ketorolac: A retrospective post-marketing surveillance study of over 20,000 patients who received ketorolac or opioids showed a small, but statistically significant risk of gastrointestinal bleeding with ketorolac (OR=1.30, 95% CI=1.11–1.52) but no significant increased risk of surgical bleeding (odds ratio=1.02, 95% CI=0.95–1.10). (2)

Data on Bone Healing

Data Supporting Ketorolac:

While there is clearly a theoretic risk of impeded bone healing following surgery, it is not clear that these “theoretic” concerns have any clinical meaning. A study of 405 consecutive patients who underwent primary lumbar posterolateral intertransverse process fusion with pedicle screw instrumentation by one surgeon suggested that there was no difference between patients who did or did not receive ketorolac. (3)

Summary of Data




J B Forrest, F Camu, I A Greer, H Kehlet, M Abdalla, F Bonnet, S Ebrahim, G Escolar, J Jage, S Pocock, G Velo, M J S Langman, Porro G Bianchi, M M Samama, E Heitlinger, POINT Investigators
Ketorolac, diclofenac, and ketoprofen are equally safe for pain relief after major surgery.
Br J Anaesth: 2002, 88(2);227-33

(P p)

B L Strom, J A Berlin, J L Kinman, P W Spitz, S Hennessy, H Feldman, S Kimmel, J L Carson
Parenteral ketorolac and risk of gastrointestinal and operative site bleeding. A postmarketing surveillance study.
JAMA: 1996, 275(5);376-82

(P p)

Ben B Pradhan, Robert L Tatsumi, Jason Gallina, Craig A Kuhns, Jeffrey C Wang, Edgar G Dawson
Ketorolac and spinal fusion: does the perioperative use of ketorolac really inhibit spinal fusion?
Spine: 2008, 33(19);2079-82

(I p)