A Double-Blind Evaluation of Ketorolac Tromethamine Versus Acetaminophen in Pediatric Tonsillectomy

Rusy, Lynn M.; Houck, Constance S.; Sullivan, Lorna J.; Ohlms, Laurie A.; Jones, Dwight T.; McGill, Trevor J.; Berde, Charles B.

doi:10.1213/00000539-199502000-00004

Cited by 48 publications

(77 citation statements)

References 15 publications

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“…A total of 36 studies met our inclusion criteria, which included 4878 subjects. This included 1446 adults and 1747 children.…”

Section: Resultsmentioning

confidence: 99%

“…The NSAIDs that were used in the trials are as follows: ASA, diclofenac, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, lornoxicam and tenoxicam . The NSAIDs were compared to various controls including the following: paracetamol, papaveretum, paracetamol with codeine, tramadol, metamizole sodium, morphine, codeine, meperidine, fentanyl, propacetamol, lidocaine infusion or placebo . Of the 41 studies, 19 were performed exclusively on children .…”

Section: Resultsmentioning

confidence: 99%

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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

Riggin

Ramakrishna

Sommer

et al. 2013

Clinical Otolaryngology

157

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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.

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“…A total of 36 studies met our inclusion criteria, which included 4878 subjects. This included 1446 adults and 1747 children.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Riggin

Ramakrishna

Sommer

et al. 2013

Clinical Otolaryngology

157

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“…pain due to mucosal injury. In one study (5), pain scores were not different between paediatric tonsillectomy patients that received either ketorolac (1 mg·kg −1 IV) or paracetamol (35 mg·kg −1 p.r.). This lack of analgesic efficacy has not been seen with all NSAIDs.…”

Section: Discussionmentioning

confidence: 98%

Rofecoxib administration to paediatric patients undergoing adenotonsillectomy

Sheeran

Rose

Fazi

et al. 2004

Pediatric Anesthesia

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“…110 However, bleeding time may be increased, 111 and some reports 112 show an increase in postoperative clinical bleeding, although there are no randomized, controlled trials that have included neonates. A small number of randomized, controlled trials in children have also shown effective analgesia, with a reduction in morphine requirements leading to reduced postoperative vomiting compared with an opioid-based analgesic.…”

Section: Reducing Pain From Surgerymentioning

confidence: 99%

Prevention and Management of Pain in the Neonate

2007

Advances in Neonatal Care

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The prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures.

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A Double-Blind Evaluation of Ketorolac Tromethamine Versus Acetaminophen in Pediatric Tonsillectomy

Cited by 48 publications

References 15 publications

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

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

Rofecoxib administration to paediatric patients undergoing adenotonsillectomy

Prevention and Management of Pain in the Neonate

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