2017-18 HSC Section 3 Green Book

Chan DK, Parikh SR. Perioperative ketorolac increases post-tonsillectomy hemorrhage in adults but not children. Laryngoscope . 2014; 124(8):1789-1793. EBM level 3.......................................................................................................................252-256 Summary : This article presents a systematic review of adult and pediatric literature. The review showed that adults are at five times increased risk for post-tonsillectomy hemorrhage with ketorolac use. In contrast, children under 18 years are not at statistically significantly increased risk. Both retrospective and prospective studies yielded consistent findings. There is no association of relative risk with pre- or postoperative administration of ketorolac. The study concluded that ketorolac can be used safely in children, but is associated with a five-fold increased bleeding risk in adults. Tsao GJ, Messner AH, Seybold J, et al. Intraoperative acupuncture for posttonsillectomy pain: a randomized, double-blind, placebo-controlled trial. Laryngoscope . 2015; 125(8):1972-1978. EBM level 3..............................................................................257-263 acupuncture or sham acupuncture. There were no significant differences in the amount of opioid medications administered or total postanesthesia care unit time between the two cohorts. Home surveys of patients but not of parents revealed significant improvements in pain control in the acupuncture treatment group postoperatively, and oral intake improved significantly earlier in the acupuncture treatment group. No adverse effects of acupuncture were reported. This study demonstrates that intraoperative acupuncture is feasible, well tolerated, and results in improved pain and earlier return of diet postoperatively. Summary : This study is a prospective, double-blind, randomized placebo-controlled trial of 59 tonsillectomy patients ages 3 to 12 years who were randomized to receive