Nonsteroidal Antiinflammatory Drugs and Perioperative Bleeding in Pediatric Tonsillectomy

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Background: Nonsteroidal antiinflammatory drugs (NSAIDs) are used for pain relief after tonsillectomy in children. However, as they inhibit platelet aggregation and prolong bleeding time, they could cause increased perioperative bleeding. The overall risk remains unclear. Objectives: The primary objective of this review was to assess the effects of NSAIDs on bleeding for pediatric tonsillectomy. There is good evidence (Kokki 2003; Romsing 1997) to show that NSAIDs are effective analgesics in children. It was not the purpose of our review to question this but rather to assess the risk of bleeding when NSAIDs are used for pain relief after pediatric tonsillectomy. Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 3, 2004); MEDLINE (inception until August 2004); EMBASE (from inception until August 2004), Current Problems (produced by the UK Medicines Control Agency); MedWatch (produced by the United States Food and Drug Administration) and the Australian Adverse Drug Reactions Bulletin in December 2001. The Cochrane Anesthesia Review Group’s hand-search coordinator performed hand-searching as required. We also contacted manufacturers and researchers in the field. Selection criteria: We included randomized controlled trials assessing NSAIDs in children up to and including 16 yr of age undergoing elective tonsillectomy or adenotonsillectomy. Data collection and analysis: Two authors independently assessed trial quality and extracted the data. We contacted study authors when necessary for additional information. We also collected information on adverse effects from the trials. Main results: We included 13 trials involving 955 children. All included trials compared NSAIDs with other analgesics or placebo and evaluated bleeding requiring surgical intervention. NSAIDs did not significantly alter number of perioperative bleeding events requiring surgical intervention; Peto odds ratio 1.46 (95% confidence interval, 0.49 to 4.40). Seven trials involving 471 children evaluated bleeding not requiring surgical intervention. NSAIDs did not significantly alter number of perioperative bleeding events not requiring surgical intervention; Peto odds ratio 1.23 (95% confidence interval, 0.44 to 3.43). Ten trials involving 837 children considered postoperative nausea and vomiting. There was less nausea and vomiting when NSAIDs were used as part of the analgesic regime compared with when NSAIDs were not used; odds ratio 0.40 (95% confidence interval, 0.23 to 0.72). Reviewers’ conclusions: NSAIDs did not cause any increase in bleeding requiring a return to the operating room. There was significantly less nausea and vomiting when NSAIDs were used compared to alternative analgesics. Citation: Cardwell M, Siviter G, Smith A. Non-steroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy (Cochrane Review). In: The Cochrane Library, Issue 2, 2005. Chichester, UK: John Wiley & Sons, Ltd. Copyright Cochrane Library; reproduced with permission.

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