BACKGROUND: Tonsillectomy in children is a common procedure to treat obstructive sleep apnea and other respiratory conditions. However, it is associated with postoperative complications, including bleeding, pain, and postoperative nausea and vomiting. Non-steroidal anti-inflammatory drugs are often used for pain management, but their effects on postoperative bleeding risk remains controversial. This meta-analysis aims to evaluate the impact of NSAIDs on postoperative bleeding and PONV in children undergoing tonsillectomy by synthesizing evidence from RCTs. MATERIALS AND METHODS: This study was conducted strictly in accordance with the PRISMA guidelines. After a thorough search of databases such as CNKI, Wanfang, Sinomed, PubMed, Embase, and the Cochrane Library, 26 randomized controlled trials were eventually included. Meta-analysis was performed using STATA software, and the impact on postoperative bleeding and postoperative nausea and vomiting was evaluated by relative risk (RR) and 95% confidence interval (CI). RESULTS: A total of 26 randomized controlled trials were included in the meta-analysis, involving 2717 pediatric patients. The risk of total postoperative bleeding [1.19, 95% CI (0.9, 1.58)], primary bleeding [RR = 1.13, 95% CI (0.77-1.65)], and secondary bleeding [RR = 1.36, 95% CI (0.86-2.14)] was not significantly affected by the use of NSAIDs during the perioperative period. Subgroup analysis showed that different types of NSAIDs and administration methods did not significantly increase the risk of postoperative bleeding. In addition, NSAIDs significantly reduced the incidence of PONV [RR = 0.78, 95% CI (0.67-0.92)]. CONCLUSION: In conclusion, this study has not identified any correlation between the application of NSAIDs and an elevated risk of bleeding after tonsillectomy in children. It lends support to the notion that these drugs can serve as an effective alternative for analgesia after tonsillectomy in children, which helps to cut down the usage of opioid drugs and consequently mitigate their associated adverse effects. However, more high-quality RCTs are necessary to further confirm these results and refine postoperative management guidelines.