Fisher Elizabeth D, Carter Julia Gm, Tsao Michelle, Maddalozzo John, Johnston Douglas
Northwestern University Feinberg School of Medicine, Department of Otolaryngology, Chicago, IL, USA.
The Johns Hopkins University Hospital, Division of Internal Medicine, Baltimore, MD, USA.
Int J Pediatr Otorhinolaryngol. 2025 Aug;195:112400. doi: 10.1016/j.ijporl.2025.112400. Epub 2025 May 19.
Conflicting evidence regarding the safety of perioperative ketorolac in children undergoing intracapsular tonsillectomy has led to some providers avoiding the use of ketorolac. However, emerging evidence indicates that ketorolac may be a safe option for pain control in these patients.
We conducted a single-center retrospective cohort study of children undergoing intracapsular tonsillectomy. Exposures were children who received perioperative pain control with ketorolac compared to children who did not receive perioperative pain control with ketorolac. The primary study outcome was post tonsillectomy hemorrhage (PTH) requiring operative control. Secondary outcomes were post operative pain readmission, time spent in the PACU, and opioids administered in the PACU.
1594 patients fit inclusion criteria; 743 received ketorolac (46.6 %) and 851 did not receive ketorolac (53.4 %). There was no difference in rate of PTH requiring operative control in patients who received ketorolac compared to patients who did not (0.7 % vs 1.4 %, Chi-square test, p = 0.1415). There was no difference in the rate of postoperative pain readmission between the two groups (2.0 % vs 3.1 %, Mid-P test, p = 0.167). The median time spent in the PACU was 13.4 % less in the ketorolac group (48 min vs 58 min, multivariate linear regression, p < 0.001). The mean total opioid dose given in the PACU was significantly less in the ketorolac group (3.7 morphine milligram equivalents (MME) vs 5.3 MME, t-test, p < 0.001).
In this cohort of children undergoing intracapsular tonsillectomy, there was no difference in the rate of PTH requiring operative control in children who received perioperative ketorolac compared to children who did not receive perioperative ketorolac. In addition, children who received ketorolac received lower total amonuts of opioids in the perioperative period and spent less time in the PACU. Further prospective, randomized clinical trials are necessary to confirm the impact of ketorolac in this population.
