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TONSILLECTOMY is one of the most common surgical procedures performed on children. Postoperative bleeding is rare but can be life threatening. During reoperation for hemostasis, induction of anesthesia is associated with a high risk of pulmonary aspiration and difficult tracheal intubation due to the presence of blood in the upper airway and stomach. The incidence of posttonsillectomy bleeding severe enough to require treatment ranges from 2–10% and that of reoperation for hemostasis ranges from 1–5.5%. Many factors are known to contribute to postoperative bleeding, including abnormal preoperative bleeding identified by questionnaire, unusual surgical indications, high postoperative blood pressure, and Sluder technique. Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly used in children for their potent antipyretic and analgesic effects. NSAID therapy has been reported to provide effective pain control without opioids after tonsillectomy and other pediatric surgical procedures. Tonsillectomy is commonly done on an outpatient basis and is associated with severe postoperative pain. Postoperative pain, nausea, and emesis must be prevented because they cause distress and prolong hospitalization. Vomiting is among the most common reasons for unscheduled readmission after outpatient tonsillectomy. NSAIDs are as effective as morphine for pain relief after surgery but are associated with a lower risk of nausea and vomiting. Thus, they are considered the agents of first choice for controlling postoperative pain after pediatric surgery. Two recent postal surveys conducted in the United Kingdom to evaluate pain treatment at home after tonsillectomy for children found that NSAIDs were used in 45–70% of patients. Nevertheless, the ability of NSAIDs to inhibit platelet cyclooxygenase (COX) may be associated with a risk of increased bleeding after tonsillectomy. NSAIDs are widely used in the pediatric population because most children are free of contraindications to these drugs, such as peptic ulcer disease or renal failure. A review of the pediatric literature on bleeding after perioperative NSAID therapy produced inconclusive results. Preoperative NSAID therapy used in prospective studies increased intraoperative blood loss by 70–80% in children undergoing tonsillectomy, requiring additional hemostatic treatment to stop bleeding. Moreover, a recent systematic review of preemptive analgesia for postoperative pain relief, including NSAIDs, failed to demonstrate the efficacy of preoperative administration of analgesics. Consequently, there is no evidence to support administration of NSAIDs preoperatively. In retrospective studies, postoperative NSAID therapy increased the incidence of bleeding, but this finding was not confirmed in prospective studies. We performed a meta-analysis to evaluate the risk of bleeding after tonsillectomy in patients treated postoperatively with NSAIDs.

Effects of Postoperative, Nonsteroidal, Antiinflammatory Drugs on Bleeding Risk after Tonsillectomy Meta-analysis of Randomized, Controlled Trials