Perioperative Pain Management with Ketorolac and Ketoprofen

Contraindications and Precautions

The American Society of Anesthesiologists recommends that neither ketorolac nor ketoprofen should be used in patients with impaired renal function, as both are contraindicated when creatinine clearance is less than 50 mL/min, and both pose a significant risk of acute kidney injury in the perioperative context 1
The use of non-selective NSAIDs, such as ketoprofen, increases the risk of cardiovascular events and hypertension 2
The association of NSAIDs with therapeutic doses of anticoagulants increases the risk of severe bleeding by 2.5 times 1

The World Health Organization recommends acetaminophen (paracetamol) 15 mg/kg every 6 hours (maximum 4 g/24h) as a base analgesic, except in hepatic dysfunction 3
The Mayo Clinic recommends opioids without active metabolites, such as fentanyl, sufentanil, and methadone, in patients with renal insufficiency 4
The Mayo Clinic advises avoiding morphine, codeine, meperidine, tramadol, and tapentadol in patients with renal insufficiency (eGFR <30 mL/min/1.73 m²) 4

The American Society of Anesthesiologists recommends dexamethasone IV 8 mg to reduce postoperative opioid requirements and nausea/vomiting 1, 5
The Journal of the American Medical Association recommends acetaminophen IV, which has demonstrated benefits after inguinal hernia repair and tonsillectomy 5
The combination of acetaminophen and opioids provides superior analgesia compared to either agent alone 6

The American College of Cardiology recommends that ketorolac and ketoprofen should not be used simultaneously, as this increases the risk of gastrointestinal bleeding, acute kidney injury, and cardiovascular thrombotic events 2
The Anaesthesia journal recommends monitoring blood pressure, BUN, creatinine, liver function tests, complete blood count, and stool occult blood test at the start of ketorolac therapy 7