• Dylan K Chan and Sanjay R Parikh.
• Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California.
• Laryngoscope. 2014 Aug 1; 124 (8): 1789-93.

Objectives/HypothesisTo evaluate the risk of post-tonsillectomy hemorrhage associated with perioperative ketorolac use.Study DesignSystematic review and meta-analysis of primary articles reporting individual-level post-tonsillectomy hemorrhage rates in subjects receiving perioperative ketorolac and matched controls. Retrospective and prospective studies were both included.MethodsPubMed search was performed for "[ketorolac OR toradol] AND tonsillectomy." Articles fulfilling inclusion criteria were subjected to meta-analysis to determine summary relative risk (RR).ResultsAdults are at five times increased risk for post-tonsillectomy hemorrhage with ketorolac use (RR: 5.64; 95% confidence interval [CI]: 2.08-15.27; P < .001). In contrast, children under 18 are not at statistically significantly increased risk (RR: 1.39; 95% CI: 0.84-2.30; P = .20). Both retrospective and prospective studies yield consistent findings. There is no association of RR with pre- or postoperative administration of ketorolac.ConclusionsKetorolac can be used safely in children, but is associated with a five-fold increased bleeding risk in adults.© 2014 The American Laryngological, Rhinological and Otological Society, Inc.

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