Non-steroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy.
BACKGROUND
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for pain relief following tonsillectomy in children. However, as they inhibit platelet aggregation and prolong bleeding time, they could cause increased perioperative bleeding. The overall risk remains unclear.


OBJECTIVE
The primary objective of this review was to assess the effects of NSAIDs on bleeding for paediatric tonsillectomy. There is good evidence (Kokki 2003; Romsing 1997) to show that NSAIDs are effective analgesics in children. It was not the remit of our review to question this, but rather to assess the risk of bleeding when NSAIDs are used for pain relief following paediatric tonsillectomy.


METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 3, 2004); MEDLINE (inception until August 2004); EMBASE (from inception until August 2004), Current Problems (produced by the UK Medicines Control Agency); MedWatch (produced by the US Food and Drug Administration) and the Australian Adverse Drug Reactions Bulletin in December 2001. The Cochrane Anaesthesia Review Group's handsearch co-ordinator performed handsearching as required. We also contacted manufacturers and researchers in the field.


METHODS
We included randomized controlled trials assessing NSAIDs in children up to and including 16 years of age, undergoing elective tonsillectomy or adenotonsillectomy.


METHODS
Two authors independently assessed trial quality and extracted the data. We contacted study authors where necessary for additional information. We also collected information on adverse effects from the trials.


RESULTS
We included 13 trials involving 955 children. All included trials compared NSAIDs with other analgesics or placebo and looked at bleeding requiring surgical intervention. NSAIDs did not significantly alter number of perioperative bleeding events requiring surgical intervention; Peto odds ratio 1.46 (95% confidence interval 0.49 to 4.40). Seven trials involving 471 children looked at bleeding not requiring surgical intervention. NSAIDs did not significantly alter number of perioperative bleeding events not requiring surgical intervention; Peto odds ratio 1.23 (95% confidence interval 0.44 to 3.43). Ten trials involving 837 children looked at post-operative nausea and vomiting. There was less nausea and vomiting when NSAIDs were used as part of the analgesic regime, compared to when NSAIDs were not used; Odds ratio 0.40 (95% confidence interval 0.23 to 0.72).


CONCLUSIONS
NSAIDs did not cause any increase in bleeding requiring a return to theatre. There was significantly less nausea and vomiting when NSAIDs were used compared to alternative analgesics.
Cardwell
M
M
Anaesthetic Department, North Manchester General Hospital, Crumpsall, Manchester, Lancashire, UK, M8 6RB. marycardwell75@hotmail.com
Siviter
G
G
Smith
A
A
D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D010149:Postoperative Pain / Q000188:drug therapy*; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D014068:Tonsillectomy / Q000009:adverse effects*
D000894:Anti-Inflammatory Agents, Non-Steroidal