Association of ibuprofen use with post-tonsillectomy bleeding in older children

Swanson, Robert T.; Schubart, Jane R.; Carr, Michele M.

doi:10.1016/j.amjoto.2018.05.009

Cited by 22 publications

(35 citation statements)

References 18 publications

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“…Older age was found to be an independent risk factor for postoperative hemorrhage. 13 Swanson et al 10 also noted increased incidence of hemorrhage in the older age group. Posttonsillectomy bleeding occurred in 12.1% of children 9 to 18 years old compared to 4.8% in children 3.1 to 6 years old.…”

Section: Introductionmentioning

confidence: 95%

“…Posttonsillectomy bleeding occurred in 12.1% of children 9 to 18 years old compared to 4.8% in children 3.1 to 6 years old. For children 9 to 18 years old, 16.7% in the ibuprofen group bled versus 7.5% in the group that did not receive ibuprofen on discharge …”

Section: Introductionmentioning

confidence: 99%

“…If given at the time of surgery, it would take 1 to 2 days to inhibit platelet function . Ibuprofen, an NSAID, has been frequently utilized for pediatric tonsillectomy analgesia without increased risk of hemorrhage …”

Section: Introductionmentioning

confidence: 99%

“…9 Ibuprofen, an NSAID, has been frequently utilized for pediatric tonsillectomy analgesia without increased risk of hemorrhage. 10 Ketorolac is an NSAID that can be administered for analgesia in postoperative patients. 11 Chan and Parikh performed a meta-analysis and systemic review of ketorolac usage and matched controls in posttonsillectomy pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

“…For children 9 to 18 years old, 16.7% in the ibuprofen group bled versus 7.5% in the group that did not receive ibuprofen on discharge. 10 Gallangher et al 14 reported on ketorolac in adult (>13 years of age) and pediatric populations (<13 years of age) in 1995 and reported increased rates of hemorrhage for patients receiving keterolac. Of the 258 patients, 19 had postoperative hemorrhage; nine bled within 24 hours (primary hemorrhage); and the rest bled within 2 to 6 days.…”

Section: Introductionmentioning

confidence: 99%

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Ketorolac usage in tonsillectomy and uvulopalatopharyngoplasty patients

McClain¹,

Williams

Yaremchuk

2019

The Laryngoscope

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Objective Postoperative pain for tonsillectomy with or without adenoidectomy or uvulopalatopharyngoplasty (UPPP) can be severe. Ketorolac is a nonsteroidal anti‐inflammatory drug that can be administered for analgesia in these patients. In the literature, ketorolac has been associated with an increased risk of hemorrhage after tonsillectomy with or without adenoidectomy. Many other surgical fields have successfully utilized this medicine for postoperative pain control without increased incidence of hemorrhage. The goal of this study was to analyze the effectiveness of ketorolac after tonsillectomy with or without adenoidectomy or UPPP in adults on postoperative hemorrhage rates. Methods Adult patients older than 18 years of age who underwent tonsillectomy with or without adenoidectomy and UPPP between 2013 and 2018 were assessed to determine hemorrhage rates. Hemorrhage rates were assessed based on patients presenting to the emergency department with complaint of hemorrhage. Results There was no significant difference between groups in the postoperative hemorrhage rates (P = .331) or the method of hemorrhage control. Conclusion Ketorolac did not increase postoperative hemorrhage rates in patients posttonsillectomy with or without adenoidectomy or UPPP. Level of Evidence 4 Laryngoscope, 130:876–879, 2020

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Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Ketorolac usage in tonsillectomy and uvulopalatopharyngoplasty patients

McClain¹,

Williams

Yaremchuk

2019

The Laryngoscope

View full text Add to dashboard Cite

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Risk Factors for Multiple Hemorrhages Following Tonsil Surgery in Children

et al. 2018

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Objectives/Hypothesis Although much is known about the incidence and risk factors for hemorrhage after tonsil surgery, the incidence and factors related to multiple episodes of hemorrhage are not well examined. Our objective was to identify risk factors that may contribute to multiple hemorrhages following tonsil surgery in children. Study Design Retrospective chart review. Methods A retrospective review was conducted of pediatric patients who experienced one or more hemorrhages following tonsillectomy/tonsillotomy, with or without adenoidectomy, between 2010 and 2016 at a single, tertiary‐care hospital. Risk factors for multiple hemorrhages were examined using a multivariable logistic regression model. Results Among the 11,140 patients who underwent tonsil surgery, 452 patients experienced one or more hemorrhages; 32 of these had multiple episodes of hemorrhage (7.1% of all patients with bleeds/0.3% of all patients). Older age (≥12 years: adjusted odds ratio [OR]: 3.13; 95% confidence interval [CI]: 1.47‐6.68) and high body mass index for age (≥85th percentile: adjusted OR: 2.26; 95% CI: 1.06‐4.85) were significantly associated with an increased risk of multiple hemorrhages in the multivariable model. Medical comorbidities, indications for surgery, surgical technique, intraoperative blood loss, and perioperative medications were not associated with multiple episodes of bleeding. Conclusions Multiple hemorrhages after tonsillectomy/tonsillotomy are uncommon. The risk of a second PTH after an initial episode is 7.1%, almost double the risk of a bleed after the initial tonsil surgery. Age > 12 years and high BMI for age may be associated with increased risk of rebleeding. After an initial bleed, increased surveillance may be warranted, particularly for patients with risk factors. Level of Evidence 4 Laryngoscope, 129:2765–2770, 2019

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Pediatric Post‐Tonsillectomy Opioid Prescribing Practices

et al. 2020

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Objective: To evaluate the effect of discharge order sets on prescribing patterns of opioids after pediatric tonsillectomy. Secondary outcomes included encounters for postoperative pain, dehydration, and bleeding.Methods: Retrospective chart review of pre-and post-intervention in pediatric post-tonsillectomy patients, 0-18 years old (n = 1486). Order sets were installed with age-specific analgesic medication defaults and recommendation of concurrent alternating scheduled ibuprofen and acetaminophen. Time-balanced pre-and post-intervention cohorts were established. Opioid outcomes calculated in morphine milligram equivalents per kilogram (MME/kg) per dosage and total prescribed.Results: Discharge order set intervention resulted in 17% reduction of opioid dose prescribed (0.095 MME/kg [95% CI, 0.092-0.099] vs. 0.079 [95% CI, 0.076-0.083], P < .001). Total number of opioid doses prescribed was reduced after order set implementation (46.4 [95% CI,.1] to 20.3 [95% CI, 19.1-21.5], P < .001). Patients <7 years old prescribed opioids remained rare in pre-and post-intervention groups (1.6% and 1.8%, respectively, P = .86). Admissions and emergency department visits for postoperative dehydration and pain were significantly reduced. Post-intervention group showed an increase in readmissions for post-tonsillectomy hemorrhage (9.2% vs. 5.2%, P = .003) which was isolated to an increase in the older post-intervention group after stratification by age.Conclusion: Utilization of order sets with standardized analgesic medication regimen of acetaminophen, ibuprofen, and opioid helped effectively reduce opioid amount per dose, total opioid amount dispensed, and variability in the total opioid amount dispensed while maintaining pain control. An increase in post-tonsillectomy hemorrhage was recognized following this implementation which did not persist after the study period despite continuation of intervention.

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Association of ibuprofen use with post-tonsillectomy bleeding in older children

Cited by 22 publications

References 18 publications

Ketorolac usage in tonsillectomy and uvulopalatopharyngoplasty patients

Ketorolac usage in tonsillectomy and uvulopalatopharyngoplasty patients

Risk Factors for Multiple Hemorrhages Following Tonsil Surgery in Children

Pediatric Post‐Tonsillectomy Opioid Prescribing Practices

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