The Use of Ibuprofen in Posttonsillectomy Analgesia and Its Effect on Posttonsillectomy Hemorrhage Rate

Pfaff, Julia A.; Hsu, Kevin; Chennupati, Sri Kiran

doi:10.1177/0194599816646363

Cited by 42 publications

(62 citation statements)

References 32 publications

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“…The incidence of reoperation for control of posttonsillectomy bleeding among the acetaminophen/codeine and the ibuprofen groups was also nonsignificant, 1.9% and 2.2%, respectively. Overall, there was no statistically significant increase in readmission or reoperation based on gender in that study . With respect to age, there was a statistically significant increase in the rate of readmission and reoperation for the 11‐ to 18‐year age group when compared with the 0‐ to 10‐year age group.…”

Section: Introductionmentioning

confidence: 59%

“…Overall, there was no statistically significant increase in readmission or reoperation based on gender in that study. 13 With respect to age, there was a statistically significant increase in the rate of readmission and reoperation for the 11-to 18-year age group when compared with the 0-to 10-year age group. Older age was found to be an independent risk factor for postoperative hemorrhage.…”

Section: Introductionmentioning

confidence: 87%

“…With respect to age, there was a statistically significant increase in the rate of readmission and reoperation for the 11‐ to 18‐year age group when compared with the 0‐ to 10‐year age group. Older age was found to be an independent risk factor for postoperative hemorrhage . Swanson et al also noted increased incidence of hemorrhage in the older age group.…”

Section: Introductionmentioning

confidence: 94%

“…Older age was found to be an independent risk factor for postoperative hemorrhage. 13 Swanson et al 10 also noted increased incidence of hemorrhage in the older age group. Posttonsillectomy bleeding occurred in 12.1% of children 9 to 18 years old compared to 4.8% in children 3.1 to 6 years old.…”

Section: Introductionmentioning

confidence: 96%

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Ketorolac usage in tonsillectomy and uvulopalatopharyngoplasty patients

McClain¹,

Williams

Yaremchuk

2019

The Laryngoscope

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Objective Postoperative pain for tonsillectomy with or without adenoidectomy or uvulopalatopharyngoplasty (UPPP) can be severe. Ketorolac is a nonsteroidal anti‐inflammatory drug that can be administered for analgesia in these patients. In the literature, ketorolac has been associated with an increased risk of hemorrhage after tonsillectomy with or without adenoidectomy. Many other surgical fields have successfully utilized this medicine for postoperative pain control without increased incidence of hemorrhage. The goal of this study was to analyze the effectiveness of ketorolac after tonsillectomy with or without adenoidectomy or UPPP in adults on postoperative hemorrhage rates. Methods Adult patients older than 18 years of age who underwent tonsillectomy with or without adenoidectomy and UPPP between 2013 and 2018 were assessed to determine hemorrhage rates. Hemorrhage rates were assessed based on patients presenting to the emergency department with complaint of hemorrhage. Results There was no significant difference between groups in the postoperative hemorrhage rates (P = .331) or the method of hemorrhage control. Conclusion Ketorolac did not increase postoperative hemorrhage rates in patients posttonsillectomy with or without adenoidectomy or UPPP. Level of Evidence 4 Laryngoscope, 130:876–879, 2020

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Section: Introductionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 96%

See 2 more Smart Citations

Ketorolac usage in tonsillectomy and uvulopalatopharyngoplasty patients

McClain¹,

Williams

Yaremchuk

2019

The Laryngoscope

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“…Regardless of the indication, a stepwise analgesic approach should be followed (Vargas-Schaffer & Cogan, 2014). Historically, nonsteroidal anti-inflammatory drugs like ibuprofen have been considered suboptimal for relieving pain because of concerns about increasing bleeding after adenotonsillectomy (D'Souza, Schmidt, Xie, Adelman, & Nardone, 2015;Pfaff, Hsu, & Chennupati, 2016). However, recent literature refuted this fear, and more otolaryngologists now recommend using ibuprofen as an initial regimen to relieve pain in patients who do not have a history of opioid use (Tan & Tunkel, 2017).…”

Section: Clinical Applicationmentioning

confidence: 99%

The Use of Codeine and Tramadol in the Pediatric Population—What is the Verdict Now?

Fortenberry¹,

Crowder²,

So³

2019

Journal of Pediatric Health Care

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Codeine and tramadol are opioid analgesics approved for the management of pain in the United States. Both agents are metabolized in the liver to active compounds via the cytochrome P450 2D6 enzyme. Case reports of pediatric patients with overactive CYP2D6 enzymes have been reported. These ultra-rapid metabolizers experience an increase in the production of active metabolites of codeine and tramadol, which can lead to oversedation, respiratory depression, and death. In 2017, the U.S. Food and Drug Administration updated their warnings regarding codeine and tramadol use in the pediatric population, making their use contraindicated in patients under the age of 12 years. OBJECTIVES 1. State the new FDA warnings regarding codeine and tramadol use in the pediatric population. 2. Describe the metabolism of codeine and tramadol. 3. Summarize adverse events from the use of codeine and tramadol reported in the literature. 4. Identify alternative non-opioids and opioids for the management of pain in children.Achieving adequate pain control in various pediatric disease states… is a delicate balance between efficacy and the potential harm from medications.

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Association of Perioperative Opioid-Sparing Multimodal Analgesia With Narcotic Use and Pain Control After Head and Neck Free Flap Reconstruction

Eggerstedt

Stenson

Ramirez

et al. 2019

JAMA Facial Plast Surg

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IMPORTANCEAn increase in narcotic prescription patterns has contributed to the current opioid epidemic in the United States. Opioid-sparing perioperative analgesia represents a means of mitigating the risk of opioid dependence while providing superior perioperative analgesia.OBJECTIVE To assess whether multimodal analgesia (MMA) is associated with reduced narcotic use and improved pain control compared with traditional narcotic-based analgesics at discharge and in the immediate postoperative period after free flap reconstructive surgery. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study assessed a consecutive sample of 65 patients (28 MMA, 37 controls) undergoing free flap reconstruction of a through-and-through mucosal defect within the head and neck region at a tertiary academic referral center from June 1, 2017, to November 30, 2018. Patients and physicians were not blinded to the patients' analgesic regimen. Patients' clinical courses were followed up for 30 days postoperatively.INTERVENTIONS Patients were administered a preoperative, intraoperative, and postoperative analgesia regimen consisting of scheduled and as-needed neuromodulating and anti-inflammatory medications, with narcotic medications reserved for refractory cases. Control patients were administered traditional narcotic-based analgesics as needed.MAIN OUTCOMES AND MEASURES Narcotic doses administered during the perioperative period and at discharge were converted to morphine-equivalent doses (MEDs) for comparison. Postoperative Defense and Veterans Pain Rating Scale pain scores (ranging from 0 [no pain] to 10 [worst pain imaginable]) were collected for the first 72 hours postoperatively as a patient-reported means of analyzing effectiveness of analgesia.RESULTS A total of 28 patients (mean [SD] age, 64.1 [12.3] years; 17 [61%] male) were included in the MMA group and 37 (mean [SD] age, 65.0 [11.0] years; 22 [59%] male) in the control group. The number of MEDs administered postoperatively was 10.0 (interquartile range [IQR], 2.7-23.1) in the MMA cohort and 89.6 (IQR, 60.0-104.5) in the control cohort (P < .001). Mean (SD) Defense and Veterans Pain Rating Scale pain scores postoperatively were 2.05 (1.41) in the MMA cohort and 3.66 (1.99) in the control cohort (P = .001). Median number of MEDs prescribed at discharge were 0 (IQR, 0-18.8) in the MMA cohort and 300.0 (IQR, 262.5-412.5) in the control cohort (P < .001). CONCLUSIONS AND RELEVANCEThe findings suggest that after free flap reconstruction, MMA is associated with reduced narcotic use at discharge and in the immediate postoperative period and with superior analgesia as measured by patient-reported pain scores. Patients receiving MMA achieved improved pain control, and the number of narcotic prescriptions in circulation were reduced.LEVEL OF EVIDENCE 3.

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The Use of Ibuprofen in Posttonsillectomy Analgesia and Its Effect on Posttonsillectomy Hemorrhage Rate

Abstract: Age is an independent risk factor for posttonsillectomy bleeding. When age is controlled, there is no statistically significant increase in the incidence of posttonsillectomy bleeding events among patients treated with ibuprofen when compared to patients treated with codeine.

Cited by 42 publications

References 32 publications

Ketorolac usage in tonsillectomy and uvulopalatopharyngoplasty patients

Ketorolac usage in tonsillectomy and uvulopalatopharyngoplasty patients

The Use of Codeine and Tramadol in the Pediatric Population—What is the Verdict Now?

Association of Perioperative Opioid-Sparing Multimodal Analgesia With Narcotic Use and Pain Control After Head and Neck Free Flap Reconstruction

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