When children have their tonsils removed, nonsteroidal anti-inflammatory drugs can be used for pain relief with no significant increase in bleeding and with less nausea and vomiting, according to a systematic review of current evidence.
NSAIDs include analgesics such as ibuprofen (Motrin) and naproxen (Aleve). Although these drugs are proven painkillers they also interfere with blood clotting, so there has been concern about excessive bleeding during or after surgery. Such problems are particularly risky for young tonsillectomy patients, because they have relatively small airways and low blood volume compared to adults.
Although doctors in the United Kingdom seem to be turning toward NSAIDs to reduce the stomach upset that frequently follows narcotic use, many in the United States prefer different surgical techniques that avoid discomfort and different drugs for the pain.
Dr. Mary Cardwell of North Manchester General Hospital in England led a team that reviewed 13 randomized controlled trials that compared NSAIDs with other painkillers or placebo after pediatric tonsillectomy. The studies included 955 children through age 16.
All of the trials analyzed whether severe bleeding that required additional surgery occurred more frequently when NSAIDS were used instead of other painkillers. However, such events are rare under any circumstances. “All the papers studied had insufficient numbers to be able to demonstrate any significant difference,” note the authors.
Seven trials involving 471 children looked at bleeding that could be controlled without a return to the operating room, and use of NSAIDs did not increase the frequency of these complications.
The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
Dr. Gretchen Siviter, a coauthor of the study and an anesthesiologist at England’s Royal Lancaster Infirmary, says use of nonsteroidals in the United Kingdom is “definitely an issue.”
“They’re proven to be good analgesics, but some doctors don’t give them because they’re worried about bleeding. I think the review might make people feel a bit easier about giving them.”
In the United States, many doctors seem to be taking a different approach. In fact, many patient advisories specifically say that NSAIDs should be avoided before and after surgery.