Journal ArticleDOI
A 2013 updated systematic review & meta-analysis of 36 randomized controlled trials; no apparent effects of non steroidal anti-inflammatory agents on the risk of bleeding after tonsillectomy.
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TLDR
Although the literature suggests that non‐steroidal anti‐inflammatory drugs (NSAIDs) are effective in controlling post‐operative pain in the paediatric population, physicians have been reluctant to utilise these medications after tonsillectomy due to concerns of increased bleeding rates.Abstract:
Background
Although the literature suggests that non-steroidal anti-inflammatory drugs (NSAIDs) are effective in controlling post-operative pain in the paediatric population, physicians have been reluctant to utilise these medications after tonsillectomy due to concerns of increased bleeding rates. While many surgeons prescribe opioid analgesics postoperatively, these are associated with a number of potential adverse side-effects including nausea, vomiting, constipation, excessive sedation and respiratory compromise.
Objective of review
To compare bleeding rates and severity between recipients of NSAIDs versus placebo or opioid analgesics for tonsillectomy.
Search strategy
Two authors independently searched electronic databases including PubMed, OVID, EMBASE and Cochrane Review from inception to July 2012. The keywords used included: Adenotonsillectomy, Tonsillectomy, Analgesia, Bleeding, Perioperative and Postoperative. These were then combined in various combinations with specific NSAIDs.
Evaluation method
A systematic review and meta-analysis of all randomised control trials comparing bleeding rates and severity between NSAIDs versus placebo or opioids post-tonsillectomy.
Results
A total of 36 studies met our inclusion criteria including 1747 children and 1446 adults. When all of the studies were combined in a meta-analysis using the most severe outcome, there was no increased risk of bleeding in those using NSAIDs after tonsillectomy. Use of NSAIDs in general [1.30 (0.90–1.88)] or in children [1.06 (0.65–1.74)] was not associated with increased risk of bleeding in general, most severe bleeding, secondary haemorrhage, readmission or need of reoperation due to bleeding. Similarly, there was no increased bleeding risk for specific NSAIDs in adults. In the studies looking at paediatric subjects, the overall odds ratio of bleeding was even lower than in the general population and not significant. This result is based on 18 studies, six of which had zero outcomes in either treatment arm. Similar to the general population analysis, there was no significant difference in any of the subanalyses: bleeds treated with reoperation, readmission or bleeds in children that could be managed conservatively. There were also no significant differences in the subanalyses of individual NSAIDs. Similarly, there was no significant difference in rates of bleeding in the subanalysis of studies that gave NSAIDs multiple times, for instance, both before and after surgery.
Conclusions
These results suggest that NSAIDs can be considered as a safe method of analgesia among children undergoing tonsillectomy.read more
Citations
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Journal ArticleDOI
Clinical Practice Guideline: Tonsillectomy in Children (Update):
Ron B. Mitchell,Sanford M. Archer,Stacey L. Ishman,Richard M. Rosenfeld,Sarah Coles,Sandra A. Finestone,Norman R. Friedman,Terri Giordano,Douglas M. Hildrew,Tae W. Kim,Robin M. Lloyd,Sanjay R. Parikh,Stanford T. Shulman,David L. Walner,Sandra A. Walsh,Lorraine C. Nnacheta +15 more
TL;DR: This update of a 2011 guideline developed by the American Academy of Otolaryngology–Head and Neck Surgery Foundation provides evidence-based recommendations on the pre-, intra- and postoperative care and management of children 1 to 18 years of age under consideration for tonsillectomy.
Journal ArticleDOI
Morphine or Ibuprofen for Post-Tonsillectomy Analgesia: A Randomized Trial
Lauren E. Kelly,Doron D. Sommer,Jayant Ramakrishna,Stephanie Hoffbauer,Sadaf Arbab-Tafti,Diane Reid,Jonathan MacLean,Gideon Koren +7 more
TL;DR: Ibuprofen in combination with acetaminophen provides safe and effective analgesia in children undergoing tonsillectomy, and post-tonsilllectomy morphine use should be limited, as it may be unsafe in certain children.
Journal ArticleDOI
Pediatric Obstructive Sleep Apnea
TL;DR: Adenotonsillectomy is the most commonly used treatment option for OSAS in childhood, but efforts are underway to identify medical treatment options.
Journal ArticleDOI
Tonsillitis and sore throat in children.
TL;DR: No national guidelines exist and the frequency of tonsil surgery varies across the country, but the indication for tonsillectomy in children is justified if 7 or more well-documented, clinically important, adequately treated episodes of throat infection occur in the preceding year.
Journal ArticleDOI
Pain after surgery in children: clinical recommendations.
TL;DR: Management of pain following surgery in children needs to not only encompass efficacy and safety in the immediate perioperative period, but also consider pain following discharge after ambulatory surgery and the potential risk of persistent postsurgical pain following major surgery.
References
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Journal ArticleDOI
Clinical practice guideline: tonsillectomy in children.
Reginald F. Baugh,Sanford M. Archer,Ron B. Mitchell,Richard M. Rosenfeld,Raouf S. Amin,James J. Burns,David H. Darrow,Terri Giordano,Ronald S. Litman,Kasey K. Li,Mary Ellen Mannix,Richard H. Schwartz,Gavin Setzen,Ellen R. Wald,Eric Wall,Gemma Sandberg,Milesh M. Patel +16 more
TL;DR: This guideline provides evidence-based recommendations on the preoperative, intraoperative, and postoperative care and management of children 1 to 18 years old under consideration for tonsillectomy and is intended for all clinicians in any setting who interact with children 1-18 years of age who may be candidates for tonsilelectomy.
Journal ArticleDOI
More Codeine Fatalities After Tonsillectomy in North American Children
Lauren E. Kelly,Michael J. Rieder,John N. van den Anker,Becky Malkin,Colin J. D. Ross,Michael Neely,Bruce Carleton,Bruce Carleton,Michael R. Hayden,Parvaz Madadi,Gideon Koren,Gideon Koren +11 more
TL;DR: Three additional fatal or life-threatening cases from North America demonstrate that analgesia with codeine or other opioids that use the CYP2D6 pathway after adenotonsillectomy may not be safe in young children with obstructive sleep apnea syndrome.
Journal ArticleDOI
Nonsteroidal anti‐inflammatory drugs and perioperative bleeding in paediatric tonsillectomy
TL;DR: There is insufficient evidence to exclude an increased risk of bleeding when NSAIDs are used in paediatric tonsillectomy, but they do however confer the benefit of a reduction in vomiting.
Journal ArticleDOI
Recurrent Hypoxemia in Children Is Associated with Increased Analgesic Sensitivity to Opiates
TL;DR: Previous recurrent hypoxemia in OSA is associated with increased analgesic sensitivity to subsequent morphine administration, and opiate dosing in children with OSA must take into account a history of recurrent Hypoxemia.
Journal ArticleDOI
Nonsteroidal antiinflammatory drugs and the risk of operative site bleeding after tonsillectomy: a quantitative systematic review.
TL;DR: The use of nonsteroidal antiinflammatory drugs for analgesia after tonsillectomy is controversial because NSAIDS, through platelet inhibition, may increase the risk of perioperative bleeding.