Kim Do Hyun, Stybayeva Gulnaz, Hwang Se Hwan
Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
Am J Otolaryngol. 2024 Nov-Dec;45(6):104461. doi: 10.1016/j.amjoto.2024.104461. Epub 2024 Aug 3.
This study aimed to evaluate the safety and efficacy of perioperative ibuprofen administration by conducting a meta-analysis of pertinent literature.
We conducted a comprehensive review of studies sourced from PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases. The studies covered the period from database inception to June 2024. A perioperative ibuprofen administration group was compared to a control group administered either saline, acetaminophen, paracetamol, or opioids. The primary outcome was post-tonsillectomy bleeding that was categorized into overall bleeding and further classified as type 1 (observed at home or evaluated in the emergency department without additional intervention), type 2 (necessitating readmission for observation), and type 3 (requiring a return to the operating room for hemorrhage control). Morbidity incidence rates for postoperative nausea and vomiting were also assessed. The secondary outcomes assessed were postoperative pain management and the frequency of analgesic drug usage. Postoperative pain management was assessed from the incidence of emergency department visits or nurses' calls for pain independent of the presence or absence of dehydration.
Twenty-two studies with 27,149 patients were included and reviewed for this meta-analysis. Post-tonsillectomy bleeding (OR = 0.9954, 95 % CI [0.8800; 1.1260], I = 0.0 %) was not significantly higher in the ibuprofen administration group compared to the control group. In subgroup analysis of post-tonsillectomy bleeding severity, ibuprofen caused clinically insignificant type 1 post-tonsillectomy bleeding that did not require intervention (OR = 1.1310 [0.7398; 1.7289]). Clinically significant bleeding requiring hospital admission (type 2) or surgical control (type 3) was not observed. Administration of ibuprofen has demonstrated efficacy in reducing the need for analgesic drugs (OR = 0.4734, 95 % CI [0.2840; 0.7893]; I = 19.8 %) and is associated with a significant decrease in the incidence of postoperative nausea and vomiting (OR = 0.4886, 95 % CI [0.3156; 0.7562], I = 34.3 %).
This study demonstrated that administration of ibuprofen for pediatric tonsillectomy did not increase the incidence of clinically significant postoperative bleeding. Ibuprofen administration decreased the incidence and severity of postoperative pain, nausea, and vomiting.
本研究旨在通过对相关文献进行荟萃分析，评估围手术期使用布洛芬的安全性和有效性。
我们对来自PubMed、SCOPUS、Embase、Web of Science和Cochrane数据库的研究进行了全面回顾。研究涵盖从数据库建立到2024年6月的时间段。将围手术期使用布洛芬的治疗组与给予生理盐水、对乙酰氨基酚、扑热息痛或阿片类药物的对照组进行比较。主要结局是扁桃体切除术后出血，分为总体出血，并进一步分为1型（在家中观察或在急诊科评估，无需额外干预）、2型（需要再次入院观察）和3型（需要返回手术室控制出血）。还评估了术后恶心和呕吐的发病率。评估的次要结局是术后疼痛管理和镇痛药使用频率。术后疼痛管理根据急诊科就诊或护士因疼痛呼叫的发生率进行评估，而不考虑是否存在脱水情况。
本荟萃分析纳入并审查了22项研究，共27149例患者。与对照组相比，布洛芬治疗组的扁桃体切除术后出血（OR = 0.9954，95% CI [0.8800; 1.1260]，I = 0.0%）并无显著增加。在扁桃体切除术后出血严重程度的亚组分析中，布洛芬导致临床上无显著意义的1型扁桃体切除术后出血，无需干预（OR = 1.1310 [0.7398; 1.7289]）。未观察到需要住院治疗（2型）或手术控制（3型）的具有临床意义的出血。使用布洛芬已证明在减少镇痛药需求方面具有疗效（OR = 0.4734，95% CI [0.2840; 0.7893]；I = 19.8%），并且与术后恶心和呕吐的发生率显著降低相关（OR = 0.4886，95% CI [0.3156; 0.7562]，I = 34.3%）。
本研究表明，小儿扁桃体切除术中使用布洛芬不会增加具有临床意义的术后出血发生率。使用布洛芬可降低术后疼痛、恶心和呕吐的发生率及严重程度。
