Ibuprofen Does Not Cause Increased Bleeding During Tonsillectomy, Adenotonsillectomy

How effective is oral ibuprofen as a preoperative analgesic after pediatric adenotonsillectomy?

Bottom line
Children treated with preoperative ibuprofen did not experience increased bleeding during or soon after tonsillectomy compared to controls.

Background: Tonsillectomy with or without adenoidectomy is among the most common surgeries performed in pediatrics. Postoperative pain is universal and moderately severe following tonsillectomy, and there is no ideal postsurgical analgesia method. Recent

literature suggests that ibuprofen, unlike other nonsteroidal anti-inflammatory drugs (NSAIDS), does not increase bleeding after pediatric tonsillectomy.

Study design: Individual case control study of 112 children who did and 105 who did not receive preoperative ibuprofen prior to tonsillectomy or adenotonsillectomy.

Setting: Department of Otolaryngology–Head and Neck Surgery and the Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia.

Synopsis: At the study site, children who underwent tonsillectomy or adenotonsillectomy from January 2013 to December 2015 did not receive preoperative ibuprofen (Group 1). Those who underwent tonsillectomy or adenotonsillectomy from January 2016 to December 2017 received oral ibuprofen 7 mg/kg preoperatively (Group 2). In Group 1, 30 children underwent tonsillectomy, and 82 underwent adenotonsillectomy; 53% of tonsillectomies were intracapsular. In Group 2, 33 children underwent tonsillectomy, and 72 underwent adenotonsillectomy; 48% of tonsillectomies were intracapsular. There was no intraoperative blood loss in excess of 50 mL and no early postoperative bleeding episodes requiring surgical control for any child in either group. Two patients in Group 1 were treated surgically for delayed bleeding, compared with three in Group 2.

Limitations included separation in time of the non-ibuprofen and ibuprofen groups, which may have introduced systematic biases, non-blinding of the surgeon documenting bleeding, and use of electrosurgical hot techniques that may have masked the negative effects of ibuprofen on hemostasis.

Citation: Michael A, Buchinsky FJ, Isaacson G. Safety of preoperative ibuprofen in pediatric tonsillectomy [published online ahead of print May 14, 2018]. Laryngoscope. doi: 10.1002/lary.27241.