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11-03-2013 | Surgery | Article

NSAIDs valid for pain relief in pediatric tonsillectomy


Free abstract

medwireNews: The use of nonsteroidal antiinflammatory drugs (NSAIDs) can be regarded as a valid method of pain relief for children undergoing tonsillectomy, say Canadian researchers.

"By analyzing all RCTs [randomized controlled trials] published to date, we found that there was no increased risk of severe bleeding overall as well as bleeding requiring operation, bleeding requiring readmission, secondary bleeds, or bleeding that could be managed conservatively," remark Jayant Ramakrishna (McMaster University, Hamilton, Ontario) and colleagues.

As reported in Clinical Otolaryngology, the team conducted a search of PubMed, OVID, EMBASE, and Cochrane Review and identified all available RCTs (n=36) comparing bleeding rates and bleeding severity with the use of NSAIDs versus placebo or opioids in both adults and children undergoing tonsillectomy.

"While many surgeons prescribe opioid analgesics post-operatively, these are associated with a number of potential adverse side effects, including nausea, vomiting, constipation, excessive sedation and respiratory compromise," explain Ramakrishna and team. On the other hand, physicians have been wary of using NSAIDs due to concerns of increased bleeding rates.

However, in the current systematic review and meta-analysis, which included 1747 children and 1446 adults, when the most severe outcomes from each study were compared, there was no increased risk after tonsillectomy for those using NSAIDs versus placebo or opioids, reports the team.

Furthermore, in both children and adults, there was no significant difference in the number of patients with increased bleeding in general, most severe bleeding, secondary bleeding, bleeding requiring reoperation or readmission, or even in bleeding that could be managed conservatively using pressure/packing or cautery.

Subgroup analysis of various individual NSAIDS including acetylsalicylic acid, diclofenac, ibuprofen, ketoprofen, ketorolac, and lornoxicam showed no significantly increased risk for bleeding with NSAID versus placebo or opioids, in either adult or pediatric populations.

In studies focusing only on children, the overall odds ratio for the most severe bleeding with NSAIDs versus placebo or opioids was in fact lower than in the overall population, and was not significant, reports the team. And again, no increased risk was observed for bleeds requiring reoperation, bleeds requiring readmission, or bleeds that could be managed conservatively.

The researchers say that compared with previous meta-analyses, theirs included a substantially increased number of studies (36 versus 7-25 RCTs). In addition, all of the measured odds ratios were homogenous, which "meaningfully increases the power of the observations and their generalizability," they say.

The team concludes: "NSAIDS can be considered as a safe method of analgesia among children undergoing tonsillectomy."

By Sally Robertson, medwireNews Reporter

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