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Does perioperative ketorolac increase bleeding risk after intracapsular tonsillectomy?

Caroline M Kolb1, Nikhita Jain2, Kristen Schillinger3

  • 1Division of Pediatric Otolaryngology, Nemours/Alfred I. DuPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA; Department of Otolaryngology - Head and Neck Surgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI, 96859, USA.

International Journal of Pediatric Otorhinolaryngology
|May 30, 2021
PubMed
Summary

Single-dose ketorolac is safe for pediatric tonsillectomies, showing no increased bleeding risk. This finding supports its use in children undergoing intracapsular tonsillectomy.

Keywords:
BleedingIntracapsular tonsillectomyKetorolacTonsillotomyToradol

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Area of Science:

  • Pediatric Surgery
  • Anesthesiology
  • Otolaryngology

Background:

  • Conflicting evidence exists on ketorolac's post-tonsillectomy bleed risk in children.
  • Surgical technique, such as intracapsular tonsillectomy, may influence this risk.

Purpose of the Study:

  • To assess the post-tonsillectomy bleed rate after single-dose ketorolac in pediatric patients undergoing intracapsular tonsillectomy.
  • To identify patient factors (age, sex, BMI, comorbidities) associated with increased bleed risk.

Main Methods:

  • Retrospective cohort study of 1920 children (Jan 2017-Dec 2018) at a tertiary pediatric center.
  • Two cohorts: ketorolac (K+, n=1458) vs. no ketorolac (NK, n=462).
  • Primary outcome: post-tonsillectomy hemorrhage requiring operative intervention.

Main Results:

  • Overall postoperative bleeding rate was 1.5%.
  • No significant difference in bleeding rates between K+ (1.4%) and NK (1.7%) groups (P=0.82).
  • Risk factors for hemorrhage included age, chronic tonsillitis, higher BMI Z-scores, ADHD, and behavioral diagnoses.

Conclusions:

  • Single-dose ketorolac is not associated with increased post-tonsillectomy bleeding risk in pediatric patients undergoing intracapsular tonsillectomy.
  • Clinicians can confidently use ketorolac in this population without increased bleeding concerns.