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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
[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

Search Outcome

One paper was found, and was relevant to the question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
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.

Comment(s)

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.

Clinical Bottom Line

The evidence to support the use of nebulised adrenaline in post tonsillectomy bleeding is limited. Local advice should be followed.

References

1. R. G. Rowlands, L. Hicklin, A. E. Hinton Novel use of nebulised adrenaline in the treatment of secondary oropharyngeal haemorrhAGE The journal of laryngology & Otology Feb 2002, Vol. 116 pp. 123-124