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Pediatric Otolaryngology

Effect of Ketorolac and Ibuprofen on Posttonsillectomy Bleeding in Children

Monday, October 2, 2023
5:30 PM - 5:36 PM East Coast USA Time
Location: 207CD

    Presenting Author(s)

  • Francesca C. Viola, MD

    Resident
    Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
    Niagara Falls, NY, United States

    • Co-Author(s)

  • Jason C. DeGiovanni, MD

    Resident
    Jacobs School of Medicine and Biomedical Sciences, Dept of Otolaryngology, United States

  • Ellen M. Piccillo, MD

    Resident
    Jacobs School of Medicine and Biomedical Sciences
    Buffalo, NY, United States

  • Beatrice R. Bacon, BS

    Medical Student
    Jacobs School of Medicine and Biomedical Sciences
    Basom, NY, United States

    • Senior Author(s)

  • Michele M. Carr, DDS MD PhD

    Professor
    Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
    Williamsville, NY, United States

Disclosure(s):
Francesca C. Viola, MD: No relevant relationships to disclose.
Michele M. Carr, DDS MD PhD: No relevant relationships to disclose.
Introduction: Post-tonsillectomy bleeding is common and can be catastrophic. The ideal pain control regimen after tonsillectomy is controversial. Our goal was to evaluate the effect on the incidence of postoperative bleeding of one intraoperative dose of Ketorolac given during pediatric tonsillectomy.

Methods: This is a retrospective chart review of 2850 tonsillectomy patients in a pediatric hospital between 2019 and 2020. There were 6 surgeons involved. Variables included patient age, gender, weight, BMI, reason for tonsillectomy, surgical method, resident involvement, intraoperative and postoperative medications, revisits, readmissions, postoperative bleeding episodes.

Results: There were 213 (7.5%) post-tonsillectomy bleeds. A subset of 2296 patients was analysed, 1106 (48.2%) females and 1185 (51.6%) males (4 unknown). Mean age was 7.2 (95% CI 7.0-7.3) yr. 2088 (91.0%) had tonsillectomy for obstruction, the rest for other reasons. 1318 (57.4%) received ketorolac and 129 (9.8%, OR 1.0) bled. 976 (42.5%) did not receive ketorolac and 84 (8.6%, OR=0.88) bled (p=.334). 666 (29.0%) patients did not receive ketorolac or ibuprofen, 45 (6.8%, OR 0.5) bled. 115 (5.0%) patients received both intraoperative ketorolac and postoperative ibuprofen; 27 (23.5%, OR 3.3) bled (p < .001). Binomial regression showed significant variables associated with post-tonsillectomy bleeding to be age (Exp(B)=1.14, p < .001), postop ibuprofen use (Exp(B)=2.95, p < .001) and intraoperative ketorolac use (Exp(B)=1.60, p=.005).

Conclusions: In this group, there was an increased incidence of bleeding in patients who were given both intraoperative ketorolac and postoperative ibuprofen.