Secondary tonsillectomy haemorrhage and non-steroidal anti-inflammatory drugs

Modern non-steroidal anti-inflammatory drugs (NSAIDs), are now widely accepted analgesics for post-tonsillectomy patients, but their effect on secondary haemorrhage has not been fully evaluated. This study attempts to evaluate the influence of NSAIDs on the secondary haemorrhage rate, and also whether mode of dissection is an important factor. The records of 557 consecutive patients undergoing tonsillectomy were studied to determine if there was a relationship between the secondary haemorrhage rate and discharge prescription of NSAIDs. There was an overall secondary haemorrhage rate of 5.2 per cent (29) and a significantly increased secondary haemorrhage rate in those taking regular NSAIDs, 11 per cent, compared to those not taking NSAIDs, 1.47 per cent, (chi 1(2) = 41.25, p < 0.001). There was a higher rate of secondary haemorrhages with bipolar dissection than with standard dissection for both those taking and not taking NSAIDs (13 per cent vs seven per cent and 2.75 per cent vs 0.87 per cent) however this was not statistically significant (chi 1(2) = 1.17, p = 0.19 and chi 1(2) = 0.773, p = 0.17). Both bipolar dissection and standard dissection individually showed very significant increases in secondary haemorrhage rate when on regular NSAIDs (chi 1(2) = 14.03, p = 0.004 and chi 1(2) = 6.19, p = 0.003). Although NSAIDs are very good analgesics, they may cause an increased secondary haemorrhage rate, and should be prescribed at discharge prescription with caution.