Western University Schulich School of Medicine & Dentistry, London, ON, Canada.
Clin Otolaryngol. 2013 Apr;38(2):115-29. doi: 10.1111/coa.12106.
Although the literature suggests that non-steroidal anti-inflammatory drugs (NSAIDs) are effective in controlling post-operative pain in the paediatric population, physicians have been reluctant to utilise these medications after tonsillectomy due to concerns of increased bleeding rates. While many surgeons prescribe opioid analgesics postoperatively, these are associated with a number of potential adverse side-effects including nausea, vomiting, constipation, excessive sedation and respiratory compromise.
To compare bleeding rates and severity between recipients of NSAIDs versus placebo or opioid analgesics for tonsillectomy.
Two authors independently searched electronic databases including PubMed, OVID, EMBASE and Cochrane Review from inception to July 2012. The keywords used included: Adenotonsillectomy, Tonsillectomy, Analgesia, Bleeding, Perioperative and Postoperative. These were then combined in various combinations with specific NSAIDs.
A systematic review and meta-analysis of all randomised control trials comparing bleeding rates and severity between NSAIDs versus placebo or opioids post-tonsillectomy.
A total of 36 studies met our inclusion criteria including 1747 children and 1446 adults. When all of the studies were combined in a meta-analysis using the most severe outcome, there was no increased risk of bleeding in those using NSAIDs after tonsillectomy. Use of NSAIDs in general [1.30 (0.90-1.88)] or in children [1.06 (0.65-1.74)] was not associated with increased risk of bleeding in general, most severe bleeding, secondary haemorrhage, readmission or need of reoperation due to bleeding. Similarly, there was no increased bleeding risk for specific NSAIDs in adults. In the studies looking at paediatric subjects, the overall odds ratio of bleeding was even lower than in the general population and not significant. This result is based on 18 studies, six of which had zero outcomes in either treatment arm. Similar to the general population analysis, there was no significant difference in any of the subanalyses: bleeds treated with reoperation, readmission or bleeds in children that could be managed conservatively. There were also no significant differences in the subanalyses of individual NSAIDs. Similarly, there was no significant difference in rates of bleeding in the subanalysis of studies that gave NSAIDs multiple times, for instance, both before and after surgery.
These results suggest that NSAIDs can be considered as a safe method of analgesia among children undergoing tonsillectomy.
尽管文献表明非甾体抗炎药（NSAIDs）在控制小儿术后疼痛方面有效，但由于担心出血率增加，医生一直不愿在扁桃体切除术后使用这些药物。虽然许多外科医生术后会开阿片类镇痛药，但这些药物会引起许多潜在的不良反应，包括恶心、呕吐、便秘、过度镇静和呼吸抑制。
比较 NSAIDs 与安慰剂或阿片类镇痛药用于扁桃体切除术后的出血率和严重程度。
两位作者独立检索了电子数据库，包括 PubMed、OVID、EMBASE 和 Cochrane Review，从成立到 2012 年 7 月。使用的关键词包括：腺样体扁桃体切除术、扁桃体切除术、镇痛、出血、围手术期和术后。然后，将这些关键词与特定的 NSAIDs 以各种组合方式结合使用。
对所有比较 NSAIDs 与安慰剂或阿片类镇痛药用于扁桃体切除术后出血率和严重程度的随机对照试验进行系统评价和荟萃分析。
共有 36 项研究符合纳入标准，包括 1747 名儿童和 1446 名成人。当将所有研究结合起来进行荟萃分析，使用最严重的结局时，扁桃体切除术后使用 NSAIDs 并不会增加出血风险。一般使用 NSAIDs [1.30（0.90-1.88）]或儿童使用 NSAIDs [1.06（0.65-1.74）]并不会增加一般、最严重出血、继发性出血、再入院或因出血而需要再次手术的风险。同样，在成人中，使用特定的 NSAIDs 也不会增加出血风险。在研究儿童患者的研究中，出血的总体优势比甚至低于普通人群，且无统计学意义。这一结果基于 18 项研究，其中 6 项研究在任何治疗组中均无结局。与普通人群分析相似，在任何亚组分析中均无显著差异：需要再次手术治疗的出血、再入院或可以保守治疗的儿童出血。在 NSAIDs 单一使用或多次使用（例如，术前和术后）的亚组分析中，也没有显著差异。同样，在 NSAIDs 多次使用的亚组分析中，出血率也没有显著差异。
这些结果表明，NSAIDs 可作为儿童扁桃体切除术后安全的镇痛方法。
