Nebulised adrenaline as a treatment for post tonsillectomy haemorrhage
Date First Published:
October 12, 2006
Last Updated:
March 6, 2007
Report by:
Ramy Saker, Emergency Medicine SpR (St Mary's Hospital, London)
Search checked by:
Nicola Batrick, St Mary's Hospital, London
Three-Part Question:
In [a patient with post tonsillectomy bleeding] is [nebulised adrenaline] effective in [reducing bleeding and subsequent complications]?
Clinical Scenario:
A 25 year old man presents to the emergency department with pharyngeal bleeding post tonsillectomy. You wonder whether haemostasis can be achieved by using nebulised adrenaline.
Search Strategy:
Medline 1950 - 02/07 using the Ovid interface
Search Details:
[post tonsillectomy.mp OR exp tonsillectomy/ OR oroharynx.mp OR exp oropharynx/ OR or oropharyn$.mp] AND [bleeding.mp OR exp hemorrhage/] AND[exp epinephrine/ OR epinephrine.mp OR adrenaline.mp] AND [nebulis$.mp OR nebuliz$ OR exp "nebulizers and vaporizers"/] limited to english language
Outcome:
One paper was found, and was relevant to the question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Novel use of nebulised adrenaline in the treatment of secondary oropharyngeal haemorrhAGE R. G. Rowlands, L. Hicklin, A. E. Hinton 2002 U.K. | 3 patients with oropharyngeal bleeding, two of which were post tonsillectomy | Case reports | Cessation of bleeding | All patients stopped bleeding | Observational study. No control. Not randomised. |
Author Commentary:
Although there is pharmacological rationale for the use of nebulised adrenaline in secondary post tonsillectomy bleeding, the clinical evidence is limited to case reports only. Nebulisation may be particularly helpful in certain groups of patients, e.g. when direct pressure with adrenaline soaked swabs is not possible. There are no randomised trials in this area and future research is required to identify best practice.
Bottom Line:
The evidence to support the use of nebulised adrenaline in post tonsillectomy bleeding is limited. Local advice should be followed.
References:
- R. G. Rowlands, L. Hicklin, A. E. Hinton. Novel use of nebulised adrenaline in the treatment of secondary oropharyngeal haemorrhAGE