Post-tonsillectomy Hemorrhage in Patients Receiving Ketorolac Analgesic

Area of Science:

• Otolaryngology
• Pharmacology
• Surgical Outcomes

Background:

• Ketorolac, a non-steroidal anti-inflammatory drug (NSAID), offers alternatives to opioids for post-tonsillectomy pain.
• Concerns exist regarding ketorolac's potential to increase post-tonsillectomy hemorrhage risk.
• Current literature lacks consensus on ketorolac's use in tonsil and adenoid surgery recovery.

Purpose of the Study:

• To determine the incidence of post-tonsillectomy hemorrhage in patients receiving postoperative ketorolac.
• To evaluate ketorolac's safety profile concerning hemorrhage in pediatric and adult patients undergoing tonsil and adenoid surgeries.

Main Methods:

• Retrospective chart review of patients who received ketorolac postoperatively.
• Study conducted at the Department of ENT-HNS, Patan Academy of Health Sciences, Nepal (April 2013 - May 2019).
• Analysis of hemorrhage rates in pediatric (<18 years) and adult (≥18 years) populations.

Main Results:

• 103 patients received postoperative ketorolac; 45 were pediatric, 58 were adult.
• 15 patients (14.6%) experienced post-tonsillectomy hemorrhage: 4 pediatric and 11 adult.
• All 5 patients requiring surgical intervention for hemorrhage were adults with recurrent tonsillitis; none required blood transfusion.

Conclusions:

• Ketorolac administration is not associated with increased post-tonsillectomy hemorrhage risk in children.
• Ketorolac can be safely used in pediatric patients following tonsil and adenoid related surgeries.
• In adult patients, especially those undergoing surgery for recurrent tonsillitis, ketorolac should be used with caution due to observed hemorrhage rates.