Adult post-tonsillectomy pain management: Opioid versus non-opioid drug comparisons

Bathula Samba SR, Stern Noah and Dworkin-Valenti James P

Objective: The primary purpose of this retrospective study was to determine if a non-steroidal anti-inflammatory drug (diclofenac sodium) plus acetaminophen was as effective as alternative opioid drug regimens, +/- ibuprofen and acetaminophen, for pain management in adults following tonsillectomy. 

Study design: Retrospective study. 

Setting: 4 hospitals in Michigan associated with the Detroit Medical Center.

Subjects and methods: Medical records of adult tonsillectomy patients (age 18 to 50 Years) were reviewed. The incidences of unscheduled post-operative visits to either the ER or ENT clinic for uncontrolled throat pain and/or postoperative bleeding complications were reviewed. 

Results: Of the 372 different patient charts reviewed for possible inclusion in this investigation, 302 individuals met the criteria for participation. These charts were divided into 3 post-operative treatment groups: 1. opioid medication plus acetaminophen for 10days, 2. opioid medication for first 3 days, plus acetaminophen and ibuprofen regimens for next 7 days, or 3. diclofenac sodium for first 5 days plus acetaminophen for 10 days. Groups 1, 2, and 3 were composed of 217, 40 and 45 subjects, respectively. The overall frequency of ER visits for pain, ENT clinic visits for pain, and ER visits for bleeding complications across subjects from all 3 treatment groups was 47 (15.6%), 41 (13.6%), and 25 (8.3%), respectively. These findings suggested that there was a significant difference in ER visits across the intervention groups. Specifically, subjects in treatment Group 1 (opioids plus acetaminophen) were 4.7 times more likely to have an ER visit (B= 1.55, p= 0.037) than subjects in Group 2 (opioids plus ibuprofen/acetaminophen) and Group 3 (diclofenac sodium plus acetaminophen). Analyses did not demonstrate a significant difference in bleeding complications (χ2= 4.26, p= 0.119) or ENT clinic visits for adjunctive pain medications across the 3 intervention groups (χ2= 4.26, p= 0.119). 

Conclusions: Results of this preliminary investigation support the administration of acetaminophen 500mg for 10 days with diclofenac sodium (NSAID) 50mg for 5 days for reliable and safe pain control in the post-tonsillectomy time frame, without significant concerns for complications like excessive bleeding or unscheduled ER or ENT clinic visits during the recovery period. 

Keywords:

Published on: May 12, 2020 Pages: 41-48

Full Text PDF Full Text HTML DOI: 10.17352/2455-1759.000120
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