Safety and efficacy of pre‐incisional peritonsillar lornoxicam in paediatric post‐tonsillectomy pain: a prospective double‐blind, placebo‐controlled, split‐body clinical study

Abdel‐Ghaffar, Hala Saad; Abdel-Azeem, Hanan G.; Roushdy, M.

doi:10.1111/coa.12351

Cited by 5 publications

(9 citation statements)

References 29 publications

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“…PTH may have been reported as primary (generally defined as occurring within 24 hours of surgery), secondary (generally defined as occurring >24 hours postoperatively), or at an undefined or unspecified time. 8…”

Section: Resultsmentioning

confidence: 99%

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

Francis

Fonnesbeck

Sathe

et al. 2017

Otolaryngol.--head neck surg.

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Objective To assess post-tonsillectomy hemorrhage (PTH), associated non-operative readmissions/revisits, and reoperations in children. Data Sources MEDLINE, EMBASE, and the Cochrane Library. Review Methods Two investigators independently screened studies against predetermined criteria and extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. We calculated unadjusted pooled estimates of PTH frequency and also conducted a Bayesian meta-analysis to estimate frequency of primary and secondary PTH and PTH-associated reoperation and revisits/readmissions by partial and total tonsillectomy and surgical approach. Results In meta-analysis, the frequency of primary and secondary PTH associated with total and partial tonsillectomy was below 4% for any technique and with overlapping confidence bounds. Pooled frequencies of PTH were also below 5% overall (4.2% for total tonsillectomy; 1.5% for partial tonsillectomy) in comparative studies. Fewer PTH occurred with tonsillectomy for obstructive sleep-disordered breathing than throat infection. In meta-analysis, frequency of PTH-associated non-operative revisits/readmission or reoperation ranged from 0.2% to 5.7% for total tonsillectomy and from 0.1% to 3.7% for partial tonsillectomy. At least four deaths were reported in case series including 1,778,342 children. Conclusions PTH occurred in roughly 4% of tonsillectomies in studies included in this review. Though studies typically did not report bleeding severity or amount, relatively few episodes of PTH necessitated reoperation for hemostasis. Nonetheless, tonsillectomy is not without risk of harm. Frequency of PTH across techniques was similar; thus we cannot conclude that a given technique is superior.

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Section: Resultsmentioning

confidence: 99%

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

Francis

Fonnesbeck

Sathe

et al. 2017

Otolaryngol.--head neck surg.

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“…Therefore, posttonsillectomy pain management is a topic of interest in many publications [8][9][10] . NSAIDS were found to be effective and safe in management of posttonsillectomy pain 1,[11][12] . Ketorolac and Diclofenac are the commonly used NSAIDS for post tonsillectomy pain.…”

Section: Discussionmentioning

confidence: 99%

“…Tarkkila et al (1999) used both (VRS) and Visual analogue scale (VAS) in assessment of post tonsillectomy pain; he used VAS also in assessment of nausea and satisfaction 13 . Abdel-Ghaffar et al,2015 used VRS in assessment of post-operative pain 1 . While Sutters et al,1995 used Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and the photographic scale of the Oucher 14 .…”

Section: Discussionmentioning

confidence: 99%

“…For assessment of intra-operative and post-operative bleeding we used the bleeding scale commonly used in the literature 1 . We found that there was no statistical difference between the two drugs.…”

Section: Discussionmentioning

confidence: 99%

“…Tonsillectomy is the most popular surgery among pediatric population 1,2 . Post-operative pain is severe and its control usually ineffective 2 .…”

Section: Introductionmentioning

confidence: 99%

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Comparative study between the effect of Diclofenac and Ketorolac in post-tonsillectomy pain management

Roushdy¹,

Abdel‐Ghaffar²,

Mohammed³

et al. 2020

Egyptian Journal of Neck Surgery and Otorhinolaryngology

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Introduction: Tonsillectomy is one of the most common surgical procedures performed in children. It is associated with significant pain Ketorolac and Diclofenac are the commonly used NSAIDS for post-tonsillectomy pain; however, they may cause bleeding. Objective: To compare between the effect of diclofenac sodium and ketorolac in post-tonsillectomy pain management and bleeding. Materials and methods: 100 children aged 6-12 years were divided into two groups; Diclofenac group (n=50 patients who received diclofenac sodium analgesia) and Ketorolac group (n= 50 patients who received ketorolac tromethamine analgesia). Intra-operative and postoperative blood loss was assessed using the following scale for bleeding assessment (0 = no bleeding, 1 = bleeding as usual, 2 = bleeding more than usual, 3 = profuse, 4 = excessive, and lastly 5 = excessive and continuous), while postoperative pain was assessed using the verbal rating scale, the total consumption of additional analgesics used in each group and the time needed to restore normal dietary habits Results: There were no statistical differences between the two groups regarding intraoperative and postoperative bleeding. On the other hand, there was no statistical difference between the two groups regarding postoperative pain management. Forty-eight and forty-six patients returned to their normal dietary habits in the first day post-operative in diclofenac group and ketorolac group respectively. Conclusions: Both ketorolac and diclofenac administered intraoperatively before the start of surgery and continued postoperatively, both drugs effectively and equally controlled post-tonsillectomy pain with no serious adverse effects.

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The Impact of Surgical Indication on Posttonsillectomy Hemorrhage: A Systematic Review and Meta‐Analysis

Gutiérrez

Shannon

Nguyen

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveTo investigate the impact of the surgical indication on posttonsillectomy bleed rates.Data SourcesPubMed, Scopus, CINAHL.Review MethodsA systematic review was performed searching for articles published from the date of inception to July 6, 2022. English language articles describing posttonsillectomy hemorrhage rates in pediatric patients (age ≤ 18) stratified by indication were selected for inclusion. A meta‐analysis of proportions with comparison (Δ) of weighted proportions was conducted. All studies were assessed for risk of bias.ResultsA total of 72 articles with 173,970 patients were selected for inclusion. The most common indications were chronic/recurrent tonsillitis (CT/RT), obstructive sleep apnea/sleep‐disordered breathing (OSA/SDB), and adenotonsillar hypertrophy (ATH). Posttonsillectomy hemorrhage rates for CT/RT, OSA/SDB, and ATH were 3.57%, 3.69%, and 2.72%, respectively. Patients operated on for a combination of CT/RT and OSA/SDB had a bleed rate of 5.99% which was significantly higher than those operated on for CT/RT alone (Δ2.42%, p = .0006), OSA/SDB alone (Δ2.30%, p = .0016), and ATH alone (Δ3.27%, p < .0001). Additionally, those operated on for a combination of ATH and CT/RT had a hemorrhage rate of 6.93%, significantly higher than those operated on for CT/RT alone (Δ3.36%, p = .0003), OSA/SDB alone (Δ3.01%, p = .0014), and ATH alone (Δ3.98%, p < .0001).ConclusionPatients operated on for multiple indications had significantly higher rates of posttonsillectomy hemorrhage than those operated on for a single surgical indication. Better documentation of patients with multiple indications would help further characterize the magnitude of the compounding effect described here.

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Safety and efficacy of pre‐incisional peritonsillar lornoxicam in paediatric post‐tonsillectomy pain: a prospective double‐blind, placebo‐controlled, split‐body clinical study

Cited by 5 publications

References 29 publications

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

Comparative study between the effect of Diclofenac and Ketorolac in post-tonsillectomy pain management

The Impact of Surgical Indication on Posttonsillectomy Hemorrhage: A Systematic Review and Meta‐Analysis

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