Tonsillectomy with or without adenoidectomy is one of the most frequently performed surgeries in the United States, with over 500,000 performed annually. Post-tonsillectomy hemorrhage is one of the most feared complications; thus, medications that could increase the risk of postoperative bleeding traditionally have been avoided. With recent FDA guidelines encouraging a departure from codeine-based medications in pediatric patients undergoing tonsillectomy, we examined the use of ibuprofen for post-tonsillectomy pain control. The records of 449 children who underwent tonsillectomy and received ibuprofen for postoperative pain control were reviewed and compared to a cohort of 1731 children who received codeine for pain postoperatively. Outcomes measured included rates of secondary post-tonsillectomy hemorrhage (PTH), secondary PTH requiring operative control, and emergency room evaluation for dehydration. Use of ibuprofen after pediatric intracapsular tonsillectomy was found to be associated with a statistically significant increase in secondary PTH and secondary PTH requiring operative control; however, ibuprofen was found to provide pain control that is at least equivalent to narcotic. Rates of secondary PTH with postoperative ibuprofen use remain within the national average. We propose that, despite the increased risk of bleeding, the use of ibuprofen is appropriate for use postoperatively in pediatric tonsillectomy patients, given its ability to control pain and lack of respiratory depression effects.
Recommended CitationD'Souza, MD, Jill N.; Adelman, BS, Julie P.; Schmidt, MD, Richard J.; and Nardone, MD, Heather C., "Postoperative Non-steroidal Anti-inflammatory Drugs and Risk of Bleeding in Pediatric Intracapsular Tonsillectomy" (2014). Department of Otolaryngology - Head and Neck Surgery Presentations and Grand Rounds. Presentation 29.