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The Use of Ibuprofen in Posttonsillectomy Analgesia and Its Effect on Posttonsillectomy Hemorrhage Rate
Julia A Pfaff1, Kevin Hsu2, Sri Kiran Chennupati3
1Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA St Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA juliapf@pcom.edu.
Insights
Ibuprofen is a safe alternative to codeine for managing post-tonsillectomy pain, as it does not increase the risk of bleeding events in pediatric patients. This finding supports ibuprofen use for post-tonsillectomy analgesia.
Area of Science:
- Pediatric surgery
- Pain management
- Pharmacology
Background:
- Post-tonsillectomy hemorrhage is a significant concern.
- Acetaminophen with codeine has been a common analgesic, but concerns exist regarding its side effects.
- Transitioning to ibuprofen for post-tonsillectomy analgesia aimed to evaluate its safety and efficacy.
Purpose of the Study:
- To compare the incidence of post-tonsillectomy bleeding between ibuprofen and codeine analgesia.
- To determine if ibuprofen increases the risk of bleeding complications after tonsillectomy in pediatric patients.
Main Methods:
- A case series with chart review was conducted at a tertiary care children's hospital.
- Pediatric patients (0-18 years) were divided into two cohorts: codeine (July 2010-June 2012) and ibuprofen (July 2012-June 2014).
- Incidence of readmission for hemorrhage and reoperation for bleeding control were compared between groups.
Main Results:
- No statistically significant difference in readmission rates for post-tonsillectomy hemorrhage between ibuprofen (3.6%) and codeine (3.4%) groups (P = .63).
- No significant difference in the incidence of second operations for bleeding control between ibuprofen (2.2%) and codeine (1.9%) groups (P = .54).
- Age (11-18 years) was identified as an independent risk factor for bleeding events.
Conclusions:
- When age is controlled, ibuprofen is not associated with a statistically significant increase in post-tonsillectomy bleeding events compared to codeine.
- Age is a significant risk factor for post-tonsillectomy bleeding.
- Ibuprofen can be considered a safe alternative for post-tonsillectomy analgesia in pediatric patients.
Objective:
To determine the effect of ibuprofen on posttonsillectomy bleeding when compared with codeine in posttonsillectomy analgesia.
Study Design:
Case series with chart review.
Setting:
Tertiary care children's hospital, Philadelphia, Pennsylvania.
Subjects And Methods:
On July 1, 2012, our institution transitioned from acetaminophen with codeine to ibuprofen for posttonsillectomy analgesia. Pediatric patients (0-18 years old) who underwent surgery from July 1, 2010, to June 30, 2012, were placed in the codeine cohort, and those who underwent surgery from July 1, 2012, to June 30, 2014, were placed in the ibuprofen cohort.
Results:
A total of 6014 patients underwent tonsillectomy between July 1, 2010, and June 30, 2014, and 211 patients presented for posttonsillectomy hemorrhage during the same period. The incidence of readmission for posttonsillectomy hemorrhage was 3.4% and 3.6% (P = .63; odds ratio [OR] = 1.07; 95% confidence interval [95% CI]: 0.811-1.410) for the codeine and ibuprofen groups, respectively, and the incidence of second operation for control of posttonsillectomy bleeding for the codeine and ibuprofen groups was 1.9% and 2.2% (P = .54; OR = 1.117; 95% CI: 0.781-1.600), respectively. Patients aged 11 to 18 years demonstrated a higher incidence of posttonsillectomy bleeding events overall. When age is controlled, multivariate logistic regression demonstrated no statistically significant increase in posttonsillectomy bleeding events among pediatric patients treated with ibuprofen versus patients treated with codeine (readmission: P = .617; OR = 0.932; 95% CI: 0.707-1.228; reoperation: P = .513; OR = 0.887; 95% CI: 0.618-1.272).
Conclusion:
Age is an independent risk factor for posttonsillectomy bleeding. When age is controlled, there is no statistically significant increase in the incidence of posttonsillectomy bleeding events among patients treated with ibuprofen when compared to patients treated with codeine.
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