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Meta-Analysis
. 2022 Jul;132(7):1473-1481.
doi: 10.1002/lary.29876. Epub 2021 Sep 24.

Post-Tonsillectomy Ibuprofen: Is There a Dose-Dependent Bleeding Risk?

Steven D Losorelli  1 , Patrick Scheffler  2 , Z J Qian  1 , Hung-Fu C Lin  1 , Mai Thy Truong  1
Affiliations
Meta-Analysis

Post-Tonsillectomy Ibuprofen: Is There a Dose-Dependent Bleeding Risk?

Steven D Losorelli et al. Laryngoscope. 2022 Jul.

Abstract

Objectives/hypothesis: Post-tonsillectomy hemorrhage (PTH) is a potentially life-threatening complication. A recent meta-analysis suggests that ibuprofen may increase the risk of PTH. The aims of this study were to 1) re-evaluate the effect of ibuprofen on PTH given additional recent evidence and 2) to evaluate a potential dose effect of ibuprofen.

Study design: Meta-analysis and meta-regression; single-institution retrospective review.

Methods: We conducted a systematic review of the literature and a meta-analysis of 12 studies comparing postoperative ibuprofen analgesia to non-nonsteroidal anti-inflammatory drug (NSAID) controls. Next, we performed a meta-regression analysis to assess for an effect of dose, if any, on rates of PTH. Five studies specifying a dose of 5 mg/kg (828 patients, 1,411 controls) and 7 studies using 10 mg/kg (5,633 patients, 7,656 controls) were included. We then conducted a novel single-institution, retrospective review of data for 1,046 patients prescribed intermediate-dose 7.5 mg/kg ibuprofen.

Results: Ibuprofen was not associated with an increased rate of PTH (log odds ratio [OR], 0.21; 95% confidence interval [CI] -0.15, 0.57). Meta-regression showed that ibuprofen dose (5 and 10 mg/kg) did not have a statistically significant effect on PTH (OR, 1.32; 95% CI 0.30, 5.84). Uncontrolled, aggregate rates of PTH across all studies were 2.29% (N = 828) for 5 mg/kg and 4.65% (N = 5,633) for 10 mg/kg dosing. The rate of secondary hemorrhage in patients prescribed 7.5 mg/kg ibuprofen was 3.10% (N = 1,046).

Conclusion: We found no statistically significant increased risk of PTH when ibuprofen is prescribed at the low or high range of commonly used clinical dosages, compared to a non-ibuprofen regimen. Further studies with less heterogeneity are needed to determine if there is a clinically relevant dose-dependent difference in PTH with ibuprofen.

Level of evidence: 3 Laryngoscope, 132:1473-1481, 2022.

Keywords: Tonsillectomy; dose-dependence; ibuprofen; pediatric; post-tonsillectomy bleed; post-tonsillectomy hemorrhage.

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References

BIBLIOGRAPHY

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