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The Effects of Pain Controlling Agents on Paediatric Tonsillectomy: A Systematic Review and Network Meta-Analysis

Do Hyun Kim1, David W Jang2, Se Hwan Hwang3

  • 1Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Clinical Otolaryngology : Official Journal of ENT-UK ; Official Journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery
|December 20, 2025
PubMed

Insights

Ibuprofen effectively manages pediatric tonsillectomy pain, while paracetamol shows promise in reducing bleeding and nausea. Ketorolac may lower nausea but increase bleeding risk, requiring further study for optimal pain management.

Area of Science:

  • Anesthesiology and Pain Management
  • Pediatric Surgery
  • Evidence-Based Medicine

Background:

  • Tonsillectomy is a common pediatric surgical procedure.
  • Effective pain management and minimizing morbidities are crucial post-tonsillectomy.
  • Various analgesics are used, but their comparative efficacy and safety in children are not fully established.

Purpose of the Study:

  • To systematically review and network meta-analyze randomized controlled trials.
  • To evaluate the effects and morbidities of perioperative analgesics in pediatric tonsillectomy patients.
  • To compare the incidence of postoperative bleeding, nausea/vomiting, and analgesic intake.

Main Methods:

  • Systematic review and network meta-analysis (NMA) of randomized controlled trials.
  • Included pediatric patients undergoing tonsillectomy.
  • Compared paracetamol, paracetamol with opioids, ibuprofen, ketorolac, opioids, and placebo/saline.

Main Results:

  • No analgesic significantly increased postoperative bleeding compared to control.
  • Ibuprofen significantly reduced the need for additional analgesics.
  • Paracetamol, ibuprofen, and ketorolac showed trends in decreasing postoperative nausea and vomiting (PONV).

Conclusions:

  • Ibuprofen appears most effective for postoperative pain relief.
  • Paracetamol demonstrated favorable trends in reducing bleeding, PONV, and analgesic requirements.
  • Ketorolac's potential benefits for PONV are offset by a tendency towards increased bleeding; further research is needed.
Abstract

Keywords:
analgesiachildhaemorrhagepainpostoperativetonsillectomy

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