Safety of selective COX-2 inhibitors in tonsillectomy patients: a systematic review protocol.

Objective: This review aims to assess the safety of selective COX-2 inhibitors in tonsillectomy patients.

Introduction: Recovery after tonsillectomy is painful and requires robust multimodal analgesia to manage; however, there is a concern for bleeding risk with non-steroidal anti-inflammatory drugs (NSAIDs). Selective COX-2 inhibitors are theoretically safe due to minimal COX-1 anti-platelet effect; however, their safety as a subclass of medication in tonsillectomy patients has not been well established despite multiple published experimental studies.

Inclusion criteria: The review will consider studies that assess patients of any age undergoing tonsillectomy or adenotonsillectomy, treated with an NSAID that is more selective for COX-2 than COX-1. The primary relevant outcome is the incidence of post-tonsillectomy bleeding.

Methods: The review will follow the JBI methodology for systematic reviews of effectiveness. The search strategy will include searches of CINAHL, the Cochrane Library, Embase, MEDLINE, SciELO, and Web of Science. Studies will be assessed by 2 independent reviewers against inclusion criteria. Studies of any date, language, or methodological quality may be included for data extraction. The standard JBI methodology for critical appraisal will be used. Effect sizes will be expressed as odds ratios, and sub-group analyses will be used to identify and manage differences in study design and patient cohorts. The GRADE approach for grading certainty of evidence will be followed.

Review registration: PROSPERO: CRD42024577071.