Commonly Used Clinical Doses of Ibuprofen Do Not Significantly Increase Risk of Post-Tonsillectomy Hemorrhage in Children

by Linda Kossoff •

Does ibuprofen increase the risk of post-tonsillectomy hemorrhage (PTH), and is the risk dose-dependent?

BOTTOM LINE

No statistically significant increase in PTH risk occurs when ibuprofen is prescribed at the low or high range of commonly used clinical dosages, compared to a non-ibuprofen regimen.

BACKGROUND: PTH is a common and potentially life-threatening complication. Some studies have implicated ibuprofen or other nonsteroidal anti-inflammatory drugs as a potential contributor to PTH. Although ibuprofen is recommended by the American Academy of Otolaryngology–Head and Neck Surgery for post-tonsillectomy analgesia, it has not issued any official dosing recommendations.

STUDY DESIGN: Meta-analysis and meta-regression; single-institution retrospective review.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif.

SYNOPSIS: Researchers conducted a literature review for studies related to extracapsular and intracapsular tonsillectomy, ibuprofen, and PTH in human randomized controlled trials, retrospective cohort studies, and prospective cohort studies from inception to January 1, 2021. Twelve studies, all concerning pediatric patients, were identified for meta-analysis to compare postoperative ibuprofen analgesia to non-nonsteroidal anti-inflammatory drug controls. A meta-regression analysis was done to assess for any effect of dose on PTH rates. Five studies specified a dose of 5 mg/kg; seven studies specified 10 mg/kg. In their retrospective review, researchers reviewed results for 1,046 patients prescribed intermediate- dose 7.5 mg/kg ibuprofen. Uncontrolled, aggregate rates of PTH across all studies were 2.29% for 5 mg/kg and 4.65% for 10 mg/kg dosing. The secondary hemorrhage rate in patients prescribed 7.5 mg/kg ibuprofen was 3.10%. Overall, ibuprofen was not associated with an increased rate of PTH, and ibuprofen dose did not have a statistically significant effect on PTH. Although authors note that this refutes some previous findings, this work excluded any study that did not specify exact dose. The main limitation was heterogeneity between studies.

CITATION: Losorelli SD, Scheffler P, Qian ZJ, et al. Post-tonsillectomy ibuprofen: Is there a dose-dependent bleeding risk? Laryngoscope. 2022;132:1473–1481.