<scp>Post‐Tonsillectomy</scp> Ibuprofen: Is There a Dose‐Dependent Bleeding Risk?

Losorelli, Steven; Scheffler, Patrick; Qian, Z Jason; Lin, Hung-Fu C; Truong, Mai Thy

doi:10.1002/lary.29876

Cited by 9 publications

(4 citation statements)

References 36 publications

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“…Ibuprofen is widely used as a first choice NSAID ( 65 ). There is no evidence that NSAIDs increase the risk of postoperative bleeding ( 66 , 67 ). The value of intravenous dexamethasone in the postoperative phase is controversial and it is not frequently used ( 68 , 69 ).…”

Section: Resultsmentioning

confidence: 99%

Treatment of recurrent acute tonsillitis—a systematic review and clinical practice recommendations

Guntinas-Lichius,

Geißler,

Mäkitie

et al. 2023

Front. Surg.

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BackgroundThere is an ongoing debate on the indications for tonsil surgery in both children and adults with recurrent acute tonsillitis. The aim is to provide practical recommendations for diagnostics and treatment for recurrent acute tonsillitis including evidence-based decision making for tonsillectomy.MethodsA systematic literature search in PubMed, Embase, Web of Science, and ScienceDirect from 2014 until April 2023 resulted in 68 articles. These were the basis for the review and a comprehensive series of consensus statements on the most important diagnostics and indications for both non-surgical and surgical therapy. A consensus paper was circulated among the authors and members of the International Head and Neck Scientific Group until a final agreement was reached for all recommendations.ResultsThe differentiation between sore throat and tonsillitis patient episodes is mostly not feasible and hence is not relevant for diagnostic decision making. Diagnostics of a tonsillitis/sore throat episode should always include a classification with a scoring system (Centor, McIssac, FeverPAIN score) to estimate the probability of a bacterial tonsillitis, mainly due to group A streptococcus (GAS). In ambiguous cases, a point-of-care test GAS swab test is helpful. Consecutive counting of the tonsillitis/sore throat episodes is important. In addition, a specific quality of life score (Tonsillectomy Outcome Inventory 14 or Tonsil and Adenoid Health Status Instrument) should be used for each episode. Conservative treatment includes a combination of paracetamol and/or non-steroidal anti-inflammatory drugs. In case of high probability of bacterial tonsillitis, and only in such cases, especially in patients at risk, standard antibiotic treatment is initiated directly or by delayed prescription. Tonsillectomy is indicated and is highly effective if the patient has had ≥7 adequately treated episodes in the preceding year, ≥5 such episodes in each of the preceding 2 years, or ≥3 such episodes in each of the preceding 3 years. An essential part of surgery is standardized pain management because severe postoperative pain can be expected in most patients.ConclusionIt is necessary to follow a stringent treatment algorithm for an optimal and evidence-based treatment for patients with recurrent acute tonsillitis. This will help decrease worldwide treatment variability, antibiotic overuse, and avoid ineffective tonsillectomy.

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Section: Resultsmentioning

confidence: 99%

Treatment of recurrent acute tonsillitis—a systematic review and clinical practice recommendations

Guntinas-Lichius,

Geißler,

Mäkitie

et al. 2023

Front. Surg.

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“…This is because celecoxib, a selective COX-2 inhibitor, does not affect platelet aggregation and is hence a safe medication with a low risk of side effects when used to treat pain following otolaryngologic procedures. Moreover, a 2022 meta-analysis by Losorelli et al 32 investigated ibuprofen for posttonsillectomy haemorrhage and found no significantly increased risk of haemorrhage with ibuprofen. Krishna et al 33 in their meta-analysis reported no increased risk of bleeding for nonaspirin NSAIDs as well.…”

Section: Discussionmentioning

confidence: 99%

Assessing the efficacy of celecoxib after tonsillectomy and/or adenoidectomy: A systematic review and meta‐analysis of randomised control trials

Banatwala,

Syed,

Ain

et al. 2024

Clinical Otolaryngology

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ObjectivesTonsillectomy and adenoidectomy are common surgical procedures that cause persistent pain, bleeding, and functional limitations. We aimed to investigate the efficacy of celecoxib compared with a placebo for managing post‐tonsillectomy or adenoidectomy pain and other adverse events.DesignSystematic review and meta‐analysis.MethodsWe conducted a systematic literature search in the PubMed, Cochrane, and Google Scholar databases from inception until July 2023. Dichotomous outcomes have been reported as risk ratios (RR) while continuous outcomes were reported using mean differences (MD). A funnel plot was drawn to investigate publication bias.ResultsFrom 1394 records identified, 6 randomised double‐blind trials comprising 591 participants undergoing tonsillectomy and/or adenoidectomy were eligible for inclusion. A high dose (400 mg) of celecoxib was effective in decreasing the pain score for ‘worst pain’ after the procedure (MD: −10.98, [95% CI: −11.53, −10.42], p < .01, I2 = 0%) while a low dose (200 mg) was not significantly effective (p = 0.31). For managing other outcomes such as vomiting (RR: 1.37 [95% CI: 0.69, 2.68], p = 0.37, I2 = 67%), diarrhoea (RR: 1.41, [95% CI: 0.75, 2.64], p = .29, I2 = 42%), dizziness/drowsiness (RR: 0.90, [95% CI: 0.71, 1.15], p = .48, I2 = 0%), functional recovery time (p = .74), and headache (p = .91), there was no significant difference between the group on celecoxib and the placebo group regardless of dosage. Finally, there was no significant difference (RR: 1.02, [95% CI: 0.91, 1.15], p = .69, I2 = 0%) in the effect of the intervention on minimum bleeding, moderate bleeding, and profuse bleeding.ConclusionThis meta‐analysis provides robust evidence pooled from high‐quality trials and raises questions about the efficacy of celecoxib for tonsillectomy and/or adenoidectomy, challenging existing perceptions.

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“…ENT surgery, with specific reference to tonsillectomy, was left out from this indication, due to the risk of Post-Tonsillectomy Hemorrhage (PTH) which is a potentially life-threatening complication. Nonetheless, a recent systematic review of the literature and a meta-analysis reported that when ibuprofen is prescribed at the low or high range of commonly used clinical dosages no statistically significant increased risk of PTH [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…The Board speculate that the low dose of ibuprofen contained in the combination could result in a safer drug profile that could warrant the use in ENT surgeries. On the other hand, further studies are needed to determine if there is a clinically relevant dose-dependent difference in PTH with ibuprofen [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Paracetamol and ibuprofen combination for the management of acute mild-to-moderate pain in children: expert consensus using the Nominal Group Technique (NGT)

et al. 2023

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Background Acute pain is a common symptom in children of all ages, and is associated with a variety of conditions. Despite the availability of guidelines, pain often remains underestimated and undertreated. Paracetamol and ibuprofen are the most commonly used drugs for analgesia in Pediatrics. Multimodal pain management by using a combination of paracetamol and ibuprofen results in greater analgesia. Methods An investigation using the Nominal Group Technique was carried out between May and August 2022. Two open (non-anonymous) questionnaires were consecutively sent to a Board of ten clinicians to understand their opinions on the use of the oral paracetamol and ibuprofen association. Answers were examined in a final meeting where conclusions were drawn. Results The board achieved a final consensus on a better analgesic power of paracetamol and ibuprofen in fixed-dose combination as compared to monotherapy, without compromising safety. Strong consensus was reached on the opinion that the fixed-dose combination of paracetamol and ibuprofen may be a useful option in case of inefficacy of one or other drug as monotherapy, especially in case of headaches, odontalgia, earache, and musculoskeletal pain. The use of the fixed combination may be also considered suitable for postoperative pain management. Conclusions The use of the fixed-dose combination may represent advantage in terms of efficacy and safety, allowing a better control of the dose of both paracetamol and ibuprofen as monotherapy, thus minimizing the risk of incorrect dosage. However, the limited evidence available highlights the need for future well designed studies to better define the advantages of this formulation in the various therapeutic areas.

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Post‐Tonsillectomy Ibuprofen: Is There a Dose‐Dependent Bleeding Risk?

Cited by 9 publications

References 36 publications

Treatment of recurrent acute tonsillitis—a systematic review and clinical practice recommendations

Treatment of recurrent acute tonsillitis—a systematic review and clinical practice recommendations

Assessing the efficacy of celecoxib after tonsillectomy and/or adenoidectomy: A systematic review and meta‐analysis of randomised control trials

Paracetamol and ibuprofen combination for the management of acute mild-to-moderate pain in children: expert consensus using the Nominal Group Technique (NGT)

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