Our Summary

This research paper looked at the rates of bleeding after a tonsillectomy (a surgery to remove the tonsils) at a major medical center. The researchers were particularly interested in whether the type of pain medicine given after the surgery affected the likelihood of bleeding. They compared two types of pain medicines: narcotics and nonsteroidal anti-inflammatory drugs (commonly known as NSAIDs, which include medicines like ibuprofen).

The researchers looked at the records of all the tonsillectomies performed at one hospital between 2013 and 2017. They found that just over 3% of the patients had to return to the hospital because of bleeding. Of those, around 0.74% didn’t need any further surgery, while 2.3% did need more surgery to stop the bleeding.

The researchers also looked at whether the bleeding rates changed after July 2015, when the hospital switched from giving patients narcotics for pain relief to giving them ibuprofen with acetaminophen. They found that the bleeding rates were slightly lower after they made the switch, but the difference wasn’t big enough to be statistically significant.

The bottom line is that bleeding after a tonsillectomy is a serious problem that often requires more surgery. But the type of pain relief used doesn’t seem to affect the likelihood of bleeding. The study didn’t find any increased risk of bleeding with ibuprofen and acetaminophen compared to narcotics.

FAQs

  1. Does the type of pain medication given after a tonsillectomy affect the likelihood of post-surgery bleeding?
  2. What was the rate of post-tonsillectomy bleeding observed in this study and how many patients required additional surgery to stop the bleeding?
  3. Did the study find any increased risk of bleeding when using ibuprofen and acetaminophen for pain relief post-tonsillectomy compared to narcotics?

Doctor’s Tip

A helpful tip a doctor might tell a patient about tonsillectomy is to follow the post-operative care instructions carefully, including taking prescribed pain medications as directed, staying hydrated, and avoiding strenuous activities. It is important to contact your healthcare provider immediately if you experience excessive bleeding, persistent pain, or any other concerning symptoms after the surgery.

Suitable For

Patients who are typically recommended for a tonsillectomy include those who suffer from recurrent or chronic tonsillitis (inflammation of the tonsils), sleep-disordered breathing such as obstructive sleep apnea, difficulty swallowing due to enlarged tonsils, or frequent throat infections. Additionally, patients with enlarged tonsils that are causing airway obstruction or difficulty breathing may also be recommended for a tonsillectomy.

Timeline

Before tonsillectomy:

  1. Patient consults with an otolaryngologist (ear, nose, and throat specialist) to discuss the need for a tonsillectomy.
  2. Patient undergoes pre-operative testing, such as blood work and possibly a throat culture.
  3. Patient is instructed to stop taking certain medications, such as blood thinners, in the days leading up to surgery.
  4. Patient is advised to fast before the surgery.
  5. Patient undergoes the tonsillectomy procedure under general anesthesia.

After tonsillectomy:

  1. Patient wakes up in the recovery room and is monitored for any immediate complications.
  2. Patient is discharged home the same day or may stay overnight in the hospital for observation.
  3. Patient experiences pain, swelling, and difficulty swallowing in the days following surgery.
  4. Patient is prescribed pain medication, typically narcotics or NSAIDs, to manage post-operative pain.
  5. Patient is advised to rest, stay hydrated, and eat soft foods to aid in recovery.
  6. Patient may experience bleeding, which can sometimes require a return to the hospital for further treatment.
  7. Patient has a follow-up appointment with the otolaryngologist to assess healing and discuss any concerns.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a tonsillectomy, including the risk of bleeding?

  2. Is there anything I can do to reduce my risk of bleeding after the surgery?

  3. What type of pain relief will be used after the surgery, and how will it be administered?

  4. Are there any medications or supplements I should avoid before or after the surgery to reduce the risk of bleeding?

  5. How will I know if I am experiencing bleeding after the surgery, and what should I do if I suspect I am bleeding?

  6. Will I need to follow any specific post-operative care instructions to reduce my risk of bleeding?

  7. How long does it typically take for the risk of bleeding to decrease after the surgery?

  8. Are there any signs or symptoms that I should watch out for that could indicate a complication such as bleeding?

  9. How often will I need to follow up with you or another healthcare provider after the surgery to monitor for potential bleeding or other complications?

  10. Is there anything else I should know about the risk of bleeding after a tonsillectomy and how it can be managed?

Reference

Authors: Fonseca ACG, Engelhardt MI, Huang ZJ, Jiang ZY, Yuksel S, Roy S. Journal: Am J Otolaryngol. 2018 Jul-Aug;39(4):445-447. doi: 10.1016/j.amjoto.2018.03.028. Epub 2018 Apr 5. PMID: 29655490