Okay, so here's the deal. Ten years or so ago, I used toradol in most patients. That included breast implant patients. It really cut down on how much postoperative analgesic use. Then one of the older plastic surgeons in town mentioned that if I had a postoperative hematoma in one of my breast augmentation patients that I would have a difficult time defending myself in a law suit. I quit using toradol in all implant patients, but still used it in reduction patients, etc. Recently, I have had repeated discussions with a CRNA regarding the use of toradol in breast augmentation patients. I don't like my reason for not using it in these patients. So I went back to the literature to either remove my reason or bolster it. The literature was not much help. There doesn't seem to be any really great studies out there for either side. Here is what I found. Anyone have any other information to help me out? (photo credit)
Dosage and Administration
Ketorolac tromethamine must not be used in children under 16 years of age. In adults, the loading dose is 30 to 60 mg IM/IV followed by a maintenance Dose --15 to 30 mg IM/IV every 6 hours or 10 mg po every 8-12 hours. Maximum Dose --150 mg on first day, then 120 mg per day, not to exceed 5 days.
- The Rational Use of Parenteral Ketorolac; Nancy E. Sloan, Pharm.D.; P&T News: May 1994, Vol. 14, No. 11
- Incidence of hematoma associated with ketorolac after TRAM flap breast reconstruction; SHARMA Sanjay, CHANG David W., KOUTZ Cindy, EVANS Gregory R. D., ROBB Geoffrey L., LANGSTEIN Howard N., KROLL Stephen S.; Plastic and Reconstructive Surgery Journal, Vol 107, No 2, pp 352-355, 2001 (abstract here)
- Facial plastic meeting yields surgical pearls; Source: Dermatology Times, Originally published: June 1, 2002
- POSTOPERATIVE HEMATOMAS ASSOCIATED WITH TORADOL; Plastic & Reconstructive Surgery. 88(5):919, November 1991; Garcha, Iqbal S.; Bostwick, John M.D.
- PERSONAL EXPERIENCES WITH TORADOL; Plastic & Reconstructive Surgery. 89(6):1183, June 1992; Dowbak, Gregory M.D.
- The Effect of Ketorolac on Microvascular Thrombosis in an Experimental Rabbit Model; Plastic & Reconstructive Surgery. 98(1):140-145, July 1996.; Shufflebarger, John V. M.D.; Doyle, James Ph.D.; Roth, Tim M.S.; Maguire, Kevin M.D.; Rothkopf, Douglas M. M.D.