Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California.
Laryngoscope. 2014 Aug;124(8):1789-93. doi: 10.1002/lary.24555. Epub 2014 May 27.
OBJECTIVES/HYPOTHESIS: To evaluate the risk of post-tonsillectomy hemorrhage associated with perioperative ketorolac use.
Systematic review and meta-analysis of primary articles reporting individual-level post-tonsillectomy hemorrhage rates in subjects receiving perioperative ketorolac and matched controls. Retrospective and prospective studies were both included.
PubMed search was performed for "[ketorolac OR toradol] AND tonsillectomy." Articles fulfilling inclusion criteria were subjected to meta-analysis to determine summary relative risk (RR).
Adults are at five times increased risk for post-tonsillectomy hemorrhage with ketorolac use (RR: 5.64; 95% confidence interval [CI]: 2.08-15.27; P < .001). In contrast, children under 18 are not at statistically significantly increased risk (RR: 1.39; 95% CI: 0.84-2.30; P = .20). Both retrospective and prospective studies yield consistent findings. There is no association of RR with pre- or postoperative administration of ketorolac.
Ketorolac can be used safely in children, but is associated with a five-fold increased bleeding risk in adults.
目的/假设：评估围手术期使用酮咯酸与扁桃体切除术后出血风险的关系。
对报告接受围手术期酮咯酸和匹配对照组的扁桃体切除术后出血率的个体水平的原始文章进行系统评价和荟萃分析。包括回顾性和前瞻性研究。
在 PubMed 上进行搜索，检索词为“[酮咯酸或托烷司琼] AND 扁桃体切除术”。符合纳入标准的文章进行荟萃分析，以确定汇总相对风险（RR）。
成年人使用酮咯酸后扁桃体切除术后出血的风险增加五倍（RR：5.64；95%置信区间[CI]：2.08-15.27；P<.001）。相比之下，18 岁以下的儿童没有统计学上显著增加的风险（RR：1.39；95% CI：0.84-2.30；P=0.20）。回顾性和前瞻性研究均得出一致的结果。酮咯酸的术前或术后给药与 RR 无关联。
酮咯酸可安全用于儿童，但与成年人出血风险增加五倍相关。
