Bleeding potential and effectiveness of perioperative ketorolac administration in tonsillectomy: A systemic review and meta-analysis

Objectives: To investigate the safety and effectiveness of perioperative ketorolac administration in tonsillectomy. Methods: In this analysis, we examined 15 studies encompassing 1249 patients, obtained from the PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases up to June 2025. Among these, 13 studies included only children, whereas 2 studies included only adults. These studies investigated the perioperative administration of ketorolac in comparison with control applications (saline, acetaminophen, or opioids). The outcomes assessed were postoperative pain levels; utilization patterns of analgesic medication in terms of quantity and frequency; and the incidence rates of postoperative nausea, vomiting, and bleeding. Results: Compared to the control group, incidence of primary (on operation day) postoperative bleeding (significant bleeding: odd ratio (OR) = 3.21, 95 % CI [0.43; 24.19], I² = 30.7 %/need surgery to control bleeding: OR = 2.71, 95 % CI [0.77; 9.56]; I² = 0.0 %) and secondary (after operation day) postoperative bleeding (significant bleeding: OR = 1.46, 95 % CI [0.63; 3.39], I² = 27.8 %/need surgery to control bleeding: OR = 2.10, 95 % CI [0.43; 10.21]; I² = 0.0 %) were not significantly higher in the ketorolac group. Compared to the control group, the ketorolac group experienced a significant decrease of postoperative nausea and vomiting (OR = 0.61, 95 % CI [0.41; 0.91], I² = 42.3 %). In addition, administration of ketorolac demonstrated efficacy in reducing postoperative pain and amount of analgesic drug compared with the control group. Conclusion: This study demonstrated that administration of ketorolac for tonsillectomy did not appear to increase the incidence of postoperative bleeding in children or adults; however, further studies are needed to confirm this finding. Additionally, ketorolac could improve postoperative emesis and early pain control.