title: Postoperative nonsteroidal anti-inflammatory drugs and risk of bleeding in pediatric intracapsular tonsillectomy.
abstract: OBJECTIVE
  In light of current FDA guidelines on opioid use in children, we sought to determine the risk of post-tonsillectomy hemorrhage (PTH) in children who received ibuprofen with acetaminophen versus those who received narcotic with acetaminophen for postoperative pain control.
  
  
  METHODS
  This was an IRB-approved retrospective chart review of patients at a tertiary-care pediatric center. The medical records of 449 children who received acetaminophen and ibuprofen following intracapsular tonsillectomy with or without adenoidectomy were reviewed (NSAID group) and compared with medical records of 1731 children who underwent intracapsular tonsillectomy and received acetaminophen with codeine or hydrocodone with acetaminophen postoperatively (narcotic group). Main outcome measure was the incidence of PTH requiring return to the operating room. Secondary outcome measures included incidence of primary PTH, secondary PTH, and postoperative evaluation in the emergency department or readmission for pain and/or dehydration.
  
  
  RESULTS
  Incidence of PTH requiring return to the operating room was higher in the NSAID group (1.6%) compared with the narcotic group (0.5%), P=0.01. Incidence of primary PTH was significantly higher in the NSAID group (2%) versus the narcotic group (0.12%), P<0.0001. Incidence of secondary PTH was 3.8% in the NSAID group and 1.1% in the narcotic group (P<0.0001).
  
  
  CONCLUSIONS
  Use of ibuprofen after intracapsular tonsillectomy in children is associated with statistically significant increase in PTH requiring return to the operating room, as well as an increase in overall rates of both primary and secondary PTH. Ibuprofen provides pain control that is at least equivalent to narcotic and is not associated with respiratory depression. Further study of ibuprofen use in the post-tonsillectomy patient is warranted.
authors.affiliation: Thomas Jefferson University Hospital, 1020 Walnut St, Philadelphia, PA 19107, United States. Electronic address: Jill.Dsouza@jefferson.edu.
authors.forename: Jill N
authors.initials: JN
authors.lastname: D'Souza
authors.affiliation: Thomas Jefferson University Hospital, 1020 Walnut St, Philadelphia, PA 19107, United States; Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, United States. Electronic address: Richard.schmidt@nemours.org.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schmidt
authors.affiliation: Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, United States. Electronic address: Li.Xie@nemours.org.
authors.forename: Li
authors.initials: L
authors.lastname: Xie
authors.affiliation: Temple University, 3401 North Broad St, Philadelphia, PA 19140, United States. Electronic address: Julie.Adelman@tuhs.temple.edu.
authors.forename: Julie P
authors.initials: JP
authors.lastname: Adelman
authors.affiliation: Thomas Jefferson University Hospital, 1020 Walnut St, Philadelphia, PA 19107, United States; Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, United States. Electronic address: heather.nardone@nemours.org.
authors.forename: Heather C
authors.initials: HC
authors.lastname: Nardone
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects; D000233:Adenoidectomy / Q000009:adverse effects; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003061:Codeine / Q000009:adverse effects; D003681:Dehydration / Q000209:etiology; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy*; D010359:Patient Readmission / Q000706:statistics & numerical data; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014068:Tonsillectomy
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen; D003061:Codeine; D007052:Ibuprofen
keywords: Ibuprofen; Intracapsular; Post-tonsillectomy hemorrhage; Tonsillectomy