JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS
AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
A&A International Anesthesia Research Society
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (57)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Møiniche, S.
Right arrow Articles by Tramèr, M. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Møiniche, S.
Right arrow Articles by Tramèr, M. R.
Related Collections
Right arrow Surgery
Right arrow Postanesthetic Care Unit
Right arrow Pediatrics
Right arrow Pharmacology

Anesth Analg 2003;96:68-77
© 2003 International Anesthesia Research Society

PEDIATRIC ANESTHESIA

Nonsteroidal Antiinflammatory Drugs and the Risk of Operative Site Bleeding After Tonsillectomy: A Quantitative Systematic Review

Steen Møiniche, MD*, Janne Rømsing, MS, Pharm, PhD{dagger}, Jørgen B. Dahl, MD, DMSc*, and Martin R. Tramèr, MD, DPhil{ddagger}

*Department of Anesthesiology and Intensive Care Medicine, Herlev University Hospital; {dagger}Department of Pharmaceutics, The Royal Danish School of Pharmacy, Copenhagen, Denmark; and {ddagger}Division of Anesthesiology, Geneva University Hospitals, Switzerland

Address correspondence to Steen Møiniche, MD, Department of Anesthesiology and Intensive Care Medicine, Herlev University Hospital, DK-2730, Copenhagen, Denmark. Address e-mail to moiniche{at}dadlnet.dk

The use of nonsteroidal antiinflammatory drugs (NSAIDs) for analgesia after tonsillectomy is controversial because NSAIDS, through platelet inhibition, may increase the risk of perioperative bleeding. We systematically searched for randomized, controlled trials that reported on the incidence of perioperative bleeding attributable to the use of NSAIDs in patients undergoing tonsillectomy. As secondary outcome measures, we analyzed the quality of pain relief and the incidence of postoperative nausea and vomiting. Twenty-five studies with data from 970 patients receiving a NSAID and 883 receiving a non-NSAID treatment or a placebo were analyzed. Data were combined using a fixed-effect model. Of four bleeding end points (intraoperative blood loss, postoperative bleeding, hospital admission, and reoperation because of bleeding), only reoperation happened significantly more often with NSAIDs: Peto-odds ratio, 2.33 (95% confidence interval [CI], 1.12–4.83) and number-needed-to-treat, 60 (95% CI, 34–277). Compared with opioids, NSAIDs were equianalgesic, and the risk of emesis was significantly decreased (relative risk, 0.73; 95% CI, 0.63–0.85; numbers-needed-to-treat, 9; 95% CI, 5–19).

IMPLICATIONS: The evidence for nonsteroidal antiinflammatory drugs to increase the risk of bleeding after tonsillectomy is equivocal, and the risk-benefit ratio is not straightforward. There is some evidence for an increased likelihood of reoperation because of bleeding. The agenda must be one of further research rather than of clinical recommendations.




This article has been cited by other articles:


Home page
 Anesth. Analg.Home page
T. Sun, O. Sacan, P. F. White, J. Coleman, R. J. Rohrich, and J. M. Kenkel
Perioperative Versus Postoperative Celecoxib on Patient Outcomes After Major Plastic Surgery Procedures
Anesth. Analg., March 1, 2008; 106(3): 950 - 958.
[Abstract] [Full Text] [PDF]

Home page
 Canadian J. AnesthesiaHome page
R. G. Cox
Anesthetic management of pediatric adenotonsillectomy
Can J Anesth, December 1, 2007; 54(12): 1021 - 1025.
[Full Text] [PDF]

Home page
 Anesth. Analg.Home page
T. J. Gan, T. A. Meyer, C. C. Apfel, F. Chung, P. J. Davis, A. S. Habib, V. D. Hooper, A. L. Kovac, P. Kranke, P. Myles, et al.
Society for Ambulatory Anesthesia Guidelines for the Management of Postoperative Nausea and Vomiting
Anesth. Analg., December 1, 2007; 105(6): 1615 - 1628.
[Abstract] [Full Text] [PDF]

Home page
 Contin Educ Anaesth Crit Care PainHome page
Feedback
CEACCP, October 1, 2007; 7(5): 177 - 178.
[Full Text] [PDF]

Home page
 EDUCATION AND PRACTICEHome page
N S Morton
Management of postoperative pain in children
Arch. Dis. Child. Ed. Pract., February 1, 2007; 92(1): ep14 - ep19.
[Full Text] [PDF]

Home page
 Br J AnaesthHome page
C. M. Bolton, P. S. Myles, T. Nolan, and J. A. Sterne
Prophylaxis of postoperative vomiting in children undergoing tonsillectomy: a systematic review and meta-analysis
Br. J. Anaesth., November 1, 2006; 97(5): 593 - 604.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
E. Munsterhjelm, T. T. Niemi, O. Ylikorkala, P. J. Neuvonen, and P. H. Rosenberg
Influence on platelet aggregation of i.v. parecoxib and acetaminophen in healthy volunteers
Br. J. Anaesth., August 1, 2006; 97(2): 226 - 231.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
T. J. Gan
Risk factors for postoperative nausea and vomiting.
Anesth. Analg., June 1, 2006; 102(6): 1884 - 1898.
[Abstract] [Full Text] [PDF]

Home page
 Canadian J. AnesthesiaHome page
D. Bainbridge, D. C. Cheng, J. E. Martin, R. Novick, and The Evidence-Based Perioperative Clinical Outcomes
NSAID-analgesia, pain control and morbidity in cardiothoracic surgery: [L'analgesie avec des AINS, le controle de la douleur et la morbidite en chirurgie cardiothoracique]
Can J Anesth, January 1, 2006; 53(1): 46 - 59.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
P. F. White
The Changing Role of Non-Opioid Analgesic Techniques in the Management of Postoperative Pain
Anesth. Analg., November 1, 2005; 101(5S_Suppl): S5 - 22.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
I. Power
Recent advances in postoperative pain therapy
Br. J. Anaesth., July 1, 2005; 95(1): 43 - 51.
[Full Text] [PDF]

Home page
 Br J AnaesthHome page
P.-A. Lonnqvist and N. S. Morton
Postoperative analgesia in infants and children
Br. J. Anaesth., July 1, 2005; 95(1): 59 - 68.
[Full Text] [PDF]

Home page
 Anesth. Analg.Home page
P. F. White
Changing Role of COX-2 Inhibitors in the Perioperative Period: Is Parecoxib Really the Answer?
Anesth. Analg., May 1, 2005; 100(5): 1306 - 1308.
[Full Text] [PDF]

Home page
 Anesth. Analg.Home page
C. K.-S. Ong, P. Lirk, R. A. Seymour, and B. J. Jenkins
The Efficacy of Preemptive Analgesia for Acute Postoperative Pain Management: A Meta-Analysis
Anesth. Analg., March 1, 2005; 100(3): 757 - 773.
[Abstract] [Full Text] [PDF]

Home page
 EDUCATION AND PRACTICEHome page
S. Turner and V. Ford
Role of the selective cyclo-oxygenase-2 (COX-2) inhibitors in children
Arch. Dis. Child. Ed. Pract., October 1, 2004; 89(2): ep46 - ep49.
[Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
S R Desikan and N G Meena
Do non-steroidal anti-inflammatory drugs increase the risk of bleeding after tonsillectomy?
Arch. Dis. Child., May 1, 2004; 89(5): 493 - 494.
[Full Text] [PDF]

Home page
 Canadian J. AnesthesiaHome page
A. S. Habib and T. J. Gan
Evidence-based management of postoperative nausea and vomiting: a review: [Le traitement des nausees et des vomissements postoperatoires fonde sur des donnees probantes : une revue]
Can J Anesth, April 1, 2004; 51(4): 326 - 341.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
E. D. Kharasch
Perioperative COX-2 Inhibitors: Knowledge and Challenges
Anesth. Analg., January 1, 2004; 98(1): 1 - 3.
[Full Text] [PDF]

Home page
 Br J AnaesthHome page
E. Munsterhjelm, T. T. Niemi, M. T. Syrjala, O. Ylikorkala, and P. H. Rosenberg
Propacetamol augments inhibition of platelet function by diclofenac in volunteers
Br. J. Anaesth., September 1, 2003; 91(3): 357 - 362.
[Abstract] [Full Text] [PDF]

Home page
 Journal of Pharmacy PracticeHome page
P. J. S. Koo
Acute Pain Management
Journal of Pharmacy Practice, August 1, 2003; 16(4): 231 - 248.
[Abstract] [PDF]

Home page
 Anesth. Analg.Home page
T. J. Gan, T. Meyer, C. C. Apfel, F. Chung, P. J. Davis, S. Eubanks, A. Kovac, B. K. Philip, D. I. Sessler, J. Temo, et al.
Consensus Guidelines for Managing Postoperative Nausea and Vomiting
Anesth. Analg., July 1, 2003; 97(1): 62 - 71.
[Abstract] [Full Text] [PDF]


Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2003 by the International Anesthesia Research Society.