Bleeding potential and effectiveness of perioperative ketorolac administration in tonsillectomy: A systemic review and meta-analysis

IF 1.3 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology Pub Date : 2025-10-15 DOI:10.1016/j.ijporl.2025.112608

Do Hyun Kim , David W. Jang , Se Hwan Hwang

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引用次数: 0

Abstract

Objectives

To investigate the safety and effectiveness of perioperative ketorolac administration in tonsillectomy.

Methods

In this analysis, we examined 15 studies encompassing 1249 patients, obtained from the PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases up to June 2025. Among these, 13 studies included only children, whereas 2 studies included only adults. These studies investigated the perioperative administration of ketorolac in comparison with control applications (saline, acetaminophen, or opioids). The outcomes assessed were postoperative pain levels; utilization patterns of analgesic medication in terms of quantity and frequency; and the incidence rates of postoperative nausea, vomiting, and bleeding.

Results

Compared to the control group, incidence of primary (on operation day) postoperative bleeding (significant bleeding: odd ratio (OR) = 3.21, 95 % CI [0.43; 24.19], I² = 30.7 %/need surgery to control bleeding: OR = 2.71, 95 % CI [0.77; 9.56]; I² = 0.0 %) and secondary (after operation day) postoperative bleeding (significant bleeding: OR = 1.46, 95 % CI [0.63; 3.39], I² = 27.8 %/need surgery to control bleeding: OR = 2.10, 95 % CI [0.43; 10.21]; I² = 0.0 %) were not significantly higher in the ketorolac group. Compared to the control group, the ketorolac group experienced a significant decrease of postoperative nausea and vomiting (OR = 0.61, 95 % CI [0.41; 0.91], I² = 42.3 %). In addition, administration of ketorolac demonstrated efficacy in reducing postoperative pain and amount of analgesic drug compared with the control group.

Conclusion

This study demonstrated that administration of ketorolac for tonsillectomy did not appear to increase the incidence of postoperative bleeding in children or adults; however, further studies are needed to confirm this finding. Additionally, ketorolac could improve postoperative emesis and early pain control.

查看原文本刊更多论文

扁桃体切除术围手术期给予酮咯酸的出血可能性和有效性：一项系统回顾和荟萃分析。

目的：探讨扁桃体切除术围手术期给予酮咯酸的安全性和有效性。方法：在这项分析中，我们检查了15项研究，包括1249名患者，这些研究来自PubMed、SCOPUS、Embase、Web of Science和Cochrane数据库，截止到2025年6月。其中，13项研究仅针对儿童，2项研究仅针对成人。这些研究调查了围手术期使用酮咯酸与对照应用（生理盐水、对乙酰氨基酚或阿片类药物）的比较。评估的结果是术后疼痛水平；镇痛药物使用的数量和频率；以及术后恶心，呕吐和出血的发生率。结果：与对照组比较，术后原发性（手术当日）出血发生率(显著出血：奇数比(OR) = 3.21, 95% CI [0.43；24.19], I2 = 30.7% /需要手术控制出血：OR = 2.71, 95% CI [0.77]；9.56);I2 = 0.0%)和术后继发出血（显著出血：OR = 1.46, 95% CI [0.63; 3.39], I2 = 27.8% /需要手术控制出血：OR = 2.10, 95% CI [0.43; 10.21]; I2 = 0.0%）在酮洛酸组中均无显著升高。与对照组相比，酮咯酸组术后恶心呕吐明显减少（OR = 0.61, 95% CI [0.41; 0.91], I2 = 42.3%）。此外，与对照组相比，给予酮咯酸在减轻术后疼痛和镇痛药量方面均有疗效。结论：本研究表明，在儿童或成人扁桃体切除术中给予酮咯酸并不会增加术后出血的发生率；然而，需要进一步的研究来证实这一发现。此外，酮咯酸可改善术后呕吐和早期疼痛控制。

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来源期刊

International journal of pediatric otorhinolaryngology 医学-耳鼻喉科学

CiteScore

3.20

自引率

6.70%

发文量

276

审稿时长

62 days

期刊介绍： The purpose of the International Journal of Pediatric Otorhinolaryngology is to concentrate and disseminate information concerning prevention, cure and care of otorhinolaryngological disorders in infants and children due to developmental, degenerative, infectious, neoplastic, traumatic, social, psychiatric and economic causes. The Journal provides a medium for clinical and basic contributions in all of the areas of pediatric otorhinolaryngology. This includes medical and surgical otology, bronchoesophagology, laryngology, rhinology, diseases of the head and neck, and disorders of communication, including voice, speech and language disorders.