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Non-steroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomyCardwell ME, Siviter G, Smith AF
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SummaryNonsteroidal anti-inflammatory drugs (NSAIDs) do not significantly increase bleeding in children having their tonsils out, and there is less nausea and vomiting when NSAIDs are usedNonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve pain immediately after an operation. Because these drugs can interfere with blood clotting there has been concern that these drugs will increase bleeding in children having their tonsils out. This could be a problem because children have relatively small breathing airways and lower blood volume compared to adults. The present review found that, with present evidence, NSAIDs did not significantly increase the need to treat bleeding. There was less nausea and vomiting when NSAIDs were used as part of the analgesic regime, compared to when NSAIDs were not used.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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April 20. 2005 AbstractBackgroundNonsteroidal anti-inflammatory drugs (NSAIDs) are used for pain relief following tonsillectomy in children. However, as they inhibit platelet aggregation and prolong bleeding time, they could cause increased perioperative bleeding. The overall risk remains unclear. ObjectivesThe primary objective of this review was to assess the effects of NSAIDs on bleeding for paediatric tonsillectomy. There is good evidence to show that NSAIDs are effective analgesics in children. It was not the remit of our review to question this, but rather to assess the risk of bleeding when NSAIDs are used for pain relief following paediatric tonsillectomy. Search strategyWe 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 US Food and Drug Administration) and the Australian Adverse Drug Reactions Bulletin in December 2001. The Cochrane Anaesthesia Review Group's handsearch co-ordinator performed handsearching as required. We also contacted manufacturers and researchers in the field. Selection criteriaWe included randomized controlled trials assessing NSAIDs in children up to and including 16 years of age, undergoing elective tonsillectomy or adenotonsillectomy. Data collection and analysisTwo authors independently assessed trial quality and extracted the data. We contacted study authors where necessary for additional information. We also collected information on adverse effects from the trials. Main resultsWe included 13 trials involving 955 children. All included trials compared NSAIDs with other analgesics or placebo and looked at 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 looked at 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 looked at post-operative nausea and vomiting. There was less nausea and vomiting when NSAIDs were used as part of the analgesic regime, compared to when NSAIDs were not used; Odds ratio 0.40 (95% confidence interval 0.23 to 0.72). Authors' conclusionsNSAIDs did not cause any increase in bleeding requiring a return to theatre. There was significantly less nausea and vomiting when NSAIDs were used compared to alternative analgesics. |
