How effective are NSAIDS at controlling tonsillectomy pain

Abstract

Tonsillectomy is one of the most commonly performed surgeries in North America. Guidelines exist for surgical candidacy for pediatric patients, but to date, there exists significant controversy and no clear guidelines advising physicians on treating pain post-tonsillectomy. Pain is the most frequent and potentially morbid complication of tonsillectomy, as it triggers return visits to physicians and hospitals following surgery, and can result in the need for hospital admission for hydration and pain control. In fact, a main point of controversy surrounds the use of a large class of analgesics known as non-steroidal anti-inflammatory drugs (NSAIDs), due to the potential for increased risk of bleeding as a result of their anti-platelet activity. However, NSAIDs have been shown to have a notable analgesic benefit in other surgical fields without conferring a significant bleeding risk. Moreover, they are known for their opioid-sparing effect, which is favored due to the many side-effects of opioids. Therefore, we undertook a systematic review of the literature to investigate the question of analgesic benefit for NSAIDs compared to other analgesics, and found that they were not different than opioids at treating post-tonsillectomy pain. However, the evidence available to answer this question was often flawed, warranting further investigation into this question. We were also especially interested in investigating commonly used analgesics such as ibuprofen and acetaminophen, so we devised a protocol that included these two medications. This protocol compares ibuprofen and acetaminophen to acetaminophen alone and seeks to show a significant opioid-sparing effect for ibuprofen. Ultimately, this topic is important because of the frequency with which tonsillectomies are performed and the importance of pain control following this procedure.