Postoperative hemorrhage after tonsillectomy in adults: is Ketorolac implied?

Cláudia Ferreira Santos, Mariana Branco, Catarina Areias, Carla André, Luís Antunes



Analysis of the prevalence of post-tonsillectomy bleeding in adults and its correlation with the use of Ketorolac for perioperative analgesia.

Study design:

Retrospective study using clinical records of adults submitted to total tonsillectomy at Hospital Garcia de Orta between January 2010 and December 2019. Adults were distributed in two groups for statistical validation.

Materials and methods:

Inclusion and exclusion criteria were defined, selecting adults submitted to isolated tonsillectomy and with data related to perioperative analgesia, according to which they were divided into two groups for statistical validation.

Statistical analysis was performed by using the SPSS v25 program, particularly the chi-square test and Fisher's test.


315 adults were selected. Ketorolac groups has a prevalence of post-tonsillectomy bleeding of 12.5% (1.4% primary event and 11.1% secondary event).


There is evidence that Ketorolac double increases post-tonsillectomy bleeding risk (OR = 2.17). However, there was no statistical significance (p> 0.05).

Palabras clave

postonsillectomy hemorrhage; tonsillectomy complications; perioperative analgesia; Ketorolac; non-steroidal anti-inflammatory drugs

Texto completo:



- Baugh RF, Archer SM, Mitchell RB, Rosenfeld RM, et al., American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg. 2011 Jan;144(1 Suppl):S1–30. Available from: DOI: 10.1177/0194599810389949

- Paradise JL, Bluestone CD, Bachman RZ, Colborn DK, et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials. N Engl J Med. 1984;310:674-83. Available from: DOI: 10.1056/NEJM198403153101102

- Powell J, O'Hara J, Carrie S, Wilson JA, Is tonsillectomy recommended in adults with recurrent tonsillitis?, BMJ. 2017 [Epub 2017 Apr 13]: 357:j1450. Available from: DOI: 10.1136/bmj.j1450

- Francis DO, Chinnadurai S, Sathe N, Rockville, MD et al. Tonsillectomy for Obstructive Sleep-Disordered Breathing or Recurrent Throat Infection in Children: Agency for Healthcare Research and Quality; AHRQ comparative effectiveness review 2017. 16(17). Available from:

- Francis DO, Fonnesbeck C, Sathe N, et al. Postoperative bleeding and associated utilization following tonsillectomy in children: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2017;156:442-455. Available from: DOI: 10.1177/0194599816683915

- Sarny S, Ossimitz G, Habermann W, Stammberger H. Hemorrhage following tonsil surgery: a multicenter prospective study. Laryngoscope 2011;121:2553–2560. Available from: DOI: 10.1002/lary.22347

- Cashman JN. The mechanisms of action of NSAIDs in analgesia. Drugs 1996; 52(Suppl 5):13–23. Available from: DOI: 10.2165/00003495-199600525-00004

- Roberts HR, Monroe DM, Escobar MA., Current concepts of hemostasis: implications for therapy. Anesthesiology 2004;100:722–730. Available from: DOI: 10.1097/00000542-200403000-00036

- Macario A, Lipman AG, Ketorolac in the era of cyclo-oxygenase-2 selective nonsteroidal anti-inflammatory drugs: a systematic review of efficacy, side effects, and regulatory issues. Pain Med. 2001 Dec;2(4):336-51. Available from: DOI: 10.1046/j.1526-4637.2001.01043

- United States Food and Drug Administration. Toradol oral (ketorolac tromethamine tablets): Reference ID: 3281582. Available from: January 14, 2019

-Chan DK, Parikh SR. Perioperative ketorolac increases post-tonsillectomy hemorrhage in adults but not children. Laryngoscope. 2014 Aug;124(8):1789-93. Available from: DOI: 10.1002/lary.24555

- Judkins, J. H., Dray, T. G., & Hubbell, R. N. Intraoperative Ketorolac and Posttonsillectomy Bleeding. Archives of Otolaryngology - Head and Neck Surgery. 1996. 122(9), 937–940. Available from: DOI:10.1001/archotol.1996.01890210017004

- Gallagher, J. E., Blauth, J., & Fornadley, J. A. Perioperative ketorolac tromethamine and postoperative hemorrhage in cases of tonsillectomy and adenoidectomy. The Laryngoscope 1995; 105(6), 606–609. Available from: DOI:10.1288/00005537-199506000-00008

- Kathleen McClain, Amy M. Williams, Kathleen Yaremchuk. Ketorolac Usage in Tonsillectomy and Uvulopalatopharyngoplasty Patients. Laryngoscope, 2019. 00:1–4. Available from: DOI: 10.1002/lary.28077

Enlaces refback

  • No hay ningún enlace refback.