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Evidence summaries

Non-Steroidal Anti-Inflammatory Drugs and Perioperative Bleeding in Paediatric Tonsillectomy

Vomiting is less common when NSAIDs are used in paediatric tonsillectomy compared to alternative analgesics but there is insufficient evidence to exclude an increased risk of bleeding with NSAIDs. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 15 studies with a total of 1 101 children. The use of NSAIDs after paediatric tonsillectomy was associated with a non-significant increase in the risk of bleeding requiring surgical intervention compared with other analgesics or placebo (table T1). NSAIDs did not significantly alter the number of perioperative bleeding events requiring non-surgical intervention. There was less vomiting when NSAIDs were used as part of the analgesic regime than when NSAIDs were not used.

Nonsteroidal anti-inflammatory drugs for paediatric tonsillectomy

OutcomeRelative effect (95% CI)Assumed risk - controlCorresponding risk - NSAID (95% CI)Participants (studies)
Perioperative bleeding requiring surgical interventionOR 1.69 (0.71 to 4.01)20 per 100033 per 1000(14 to 76)1 044(14 studies)
Perioperative bleeding requiring non-surgical interventionOR 0.99 (0.41 to 2.4)50 per 100050 per 1000(21 to 112)745(10 studies)
VomitingRR 0.72 (0.61 to 0.85)357 per 1000257 per 1000(218 to 303)1 021(13 studies)

    References

    • Lewis SR, Nicholson A, Cardwell ME et al. Nonsteroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy. Cochrane Database Syst Rev 2013;(7):CD003591. [PubMed]

Primary/Secondary Keywords