Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
Int J Pediatr Otorhinolaryngol. 2024 Sep;184:112078. doi: 10.1016/j.ijporl.2024.112078. Epub 2024 Aug 21.
To assess the safety and effectiveness of perioperative ibuprofen in pediatric tonsillectomy through a meta-analysis of relevant randomized controlled trials.
We conducted a comprehensive review of studies available in PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases up to June 2024. This analysis compared perioperative ibuprofen administration to control groups (saline, acetaminophen, or opioids). Outcomes assessed were postoperative pain management, as indicated by the frequency of analgesic use, and morbidity rates, which included the incidence of postoperative nausea and vomiting and post-tonsillectomy hemorrhage (PTH). PTH was further categorized as primary (occurring on the day of operation) or secondary (occurring after the day of operation), and classified as type 1 (observed at home or evaluated in the emergency department without further intervention), type 2 (requiring readmission for observation), or type 3 (necessitating a return to the operating room for hemorrhage control).
This analysis included nine studies involving a total of 1545 patients. Incidences of primary PTH (OR = 1.0949, 95 % CI [0.4169; 2.8755], I = 0.0 %), secondary PTH (OR = 1.6433 95 % CI [0.7783; 3.4695], I = 0.1 %), and overall PTH (OR = 1.4296 95 % CI [0.8383; 2.4378], I = 0.0 %) were not significantly higher in the ibuprofen group than the control groups. Administration of ibuprofen led to a significant decrease in postoperative nausea and vomiting (OR = 0.4228 95 % CI [0.2500; 0.7150], I = 40.0 %) and frequency of postoperative analgesic uptake (OR = 0.4734 95 % CI [0.2840; 0.7893]; I = 19.8 %). There was no difference in bleeding by type between the ibuprofen and control groups.
Our meta-analysis demonstrated that administration of ibuprofen for pediatric tonsillectomy did not significantly increase the incidence of postoperative bleeding but did decrease postoperative emesis and improve pain control.
通过对相关随机对照试验的荟萃分析，评估围手术期布洛芬在小儿扁桃体切除术的安全性和有效性。
我们对截至 2024 年 6 月在 PubMed、SCOPUS、Embase、Web of Science 和 Cochrane 数据库中可用的研究进行了全面综述。本分析将围手术期给予布洛芬与对照组（生理盐水、对乙酰氨基酚或阿片类药物）进行了比较。评估的结果是术后疼痛管理，如镇痛药使用频率，以及发病率，包括术后恶心和呕吐以及扁桃体切除术后出血（PTH）。PTH 进一步分为原发性（发生在手术当天）或继发性（发生在手术当天之后），并分为 1 型（在家中观察或在急诊科评估无需进一步干预）、2 型（需要入院观察）或 3 型（需要返回手术室进行出血控制）。
该分析包括 9 项研究，共涉及 1545 名患者。原发性 PTH 的发生率（OR=1.0949，95%CI[0.4169;2.8755]，I=0.0）、继发性 PTH（OR=1.6433，95%CI[0.7783;3.4695]，I=0.1）和总体 PTH（OR=1.4296，95%CI[0.8383;2.4378]，I=0.0）在布洛芬组与对照组之间无显著差异。布洛芬组术后恶心和呕吐（OR=0.4228，95%CI[0.2500;0.7150]，I=40.0）和术后镇痛药物使用频率（OR=0.4734，95%CI[0.2840;0.7893]；I=19.8）显著降低。布洛芬组与对照组之间的出血类型无差异。
我们的荟萃分析表明，小儿扁桃体切除术后给予布洛芬并不会显著增加术后出血的发生率，但确实可以减少术后呕吐并改善疼痛控制。
