Evaluating the risks and benefits of ketorolac in transoral robotic surgery

Abstract

Transoral Robotic Surgery (TORS) is increasingly used for oropharyngeal neoplasms and obstructive sleep apnea. Post-operative pain and bleeding remain concerns. Ketorolac has proved to be a safe alternative or addition to narcotics in other operations, but has not been thoroughly evaluated in TORS. A retrospective review was carried out on all TORS cases at our institution between April 2012 and March 2019, with the vast majority of cases performed starting in 2017. Post-operative bleed rates were compared between those who received Ketorolac and those who did not. Secondary outcomes evaluated included post-operative pain scores and need for feeding tube upon discharge. A total of 81 TORS cases were evaluated, with 37 patients receiving Ketorolac. Six (7.4%) patients reported post-operative bleeding, with one major and five minor bleeds. The patient with major bleeding requiring operative intervention did not receive Ketorolac. All five patients with minor bleeding received Ketorolac, but no bleeds occurred in the immediate post-operative setting while receiving Ketorolac. The average time of bleeding was 8 days post-operative. There were no significant differences in pain scores or time to feeding tube removal. This preliminary study shows that Ketorolac use in the postoperative pain management after TORS does not increase major bleeding risk without benefits in pain management. There was increased risk of minor bleeding not requiring intervention, but this was not significant. Future prospective studies are needed to determine if it improves pain and swallowing and decreases narcotic requirements following TORS.

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Funding

The authors did not receive support or funding for this study.

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All authors contributed to study conception and design. Material preparation, data collection, and analysis sere performed by MS, SD, and DZ. The first draft of the manuscript was written by MS and SD, and MS and MS wrote and edited subsequent drafts. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Michael W. Sim.

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The authors have no relevant financial or non-financial interests to disclose.

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Our retrospective study was conducted using data obtained for clinical purposes. The Indiana University Institutional Review Board gave an official waiver of ethical approval.

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Sandelski, M.M., Drejet, S.M., Zimmer, D. et al. Evaluating the risks and benefits of ketorolac in transoral robotic surgery. J Robotic Surg (2021). https://doi.org/10.1007/s11701-021-01190-y

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Keywords

  • Transoral robotic surgery
  • Postoperative hemorrhage
  • Postoperative bleed
  • Oropharyngeal squamous cell carcinoma
  • Ketorolac
  • Toradol