Our Summary

This research paper examines the use of a drug called ketorolac in managing pain after surgeries related to the tonsils and adenoids. Ketorolac is a type of non-steroidal anti-inflammatory drug, and is thought to cause less sleepiness and less post-surgery nausea and vomiting compared to opioids. However, some studies have suggested that it might increase the risk of bleeding after tonsil removal.

The researchers looked back at medical records from patients who underwent tonsil and adenoid related surgeries between April 2013 and May 2019, and had received ketorolac for pain management. They were particularly interested in how many of these patients experienced post-surgery bleeding.

They found that out of 103 patients, 15 experienced post-surgery bleeding. Of these, four were under 18 years old, and 11 were 18 or older. Five of these patients needed further surgery to control the bleeding, but all of them were adults and had undergone surgery due to repeat tonsil infections. No patients needed a blood transfusion.

The researchers conclude that ketorolac does not increase the risk of post-surgery bleeding in children and can be safely used for pain management in these cases. However, in adults, particularly those having surgery due to repeat tonsil infections, the drug should be used with caution.

FAQs

  1. What is ketorolac and why is it used in tonsil and adenoid surgeries?
  2. Does ketorolac increase the risk of post-surgery bleeding?
  3. Is ketorolac safe to use for pain management in children after tonsil and adenoid surgeries?

Doctor’s Tip

A helpful tip a doctor might tell a patient about tonsillectomy is to follow post-operative care instructions carefully, including taking pain medication as prescribed and avoiding strenuous activities that could increase the risk of bleeding. It is also important to stay hydrated and get plenty of rest during the recovery period. If any unusual symptoms, such as excessive bleeding or signs of infection, occur, it is important to contact your healthcare provider immediately.

Suitable For

Overall, patients who are typically recommended for tonsillectomy include those who have recurrent tonsillitis (usually defined as more than seven episodes in one year, more than five episodes in two years, or more than three episodes in three years), obstructive sleep-disordered breathing (such as sleep apnea), or other complications related to the tonsils such as abscesses or tumors.

In terms of age, tonsillectomy is more commonly recommended for children, as they tend to have more frequent and severe tonsil-related issues compared to adults. However, adults may also undergo tonsillectomy if they have persistent or severe tonsil-related problems.

In summary, patients who are recommended for tonsillectomy are typically those who have recurrent tonsillitis, obstructive sleep-disordered breathing, or other complications related to the tonsils. The decision to proceed with tonsillectomy should be made in consultation with a healthcare provider who can assess the individual patient’s medical history and symptoms.

Timeline

Before tonsillectomy:

  • Patient experiences recurrent tonsillitis or other issues with the tonsils
  • Consultation with an ENT specialist to discuss the need for surgery
  • Pre-operative assessment and preparation, including blood tests and possible imaging studies
  • Informed consent process explaining the risks and benefits of the surgery
  • Fasting before the procedure
  • Administration of anesthesia during the surgery

After tonsillectomy:

  • Recovery period in the hospital or at home, depending on the age of the patient and the complexity of the surgery
  • Pain management with medications such as ketorolac
  • Monitoring for any signs of bleeding, infection, or other complications
  • Follow-up appointments with the surgeon to assess healing and discuss any concerns
  • Gradual return to normal diet and activities
  • Complete healing of the surgical site and resolution of symptoms such as sore throat or difficulty swallowing

Overall, the timeline for a patient before and after tonsillectomy can vary depending on individual factors such as age, overall health, and the specific reason for the surgery. It is important for patients to follow their healthcare provider’s recommendations for a smooth recovery process.

What to Ask Your Doctor

Some questions a patient should ask their doctor about tonsillectomy and pain management with ketorolac include:

  1. What are the potential risks and benefits of using ketorolac for pain management after my tonsillectomy?
  2. Are there any alternative pain management options that may be safer for me?
  3. What steps will be taken to monitor me for any signs of post-surgery bleeding while using ketorolac?
  4. How will my age and medical history (such as previous tonsil infections) affect the decision to use ketorolac for pain management?
  5. What should I do if I experience any unusual symptoms or side effects while taking ketorolac after my surgery?
  6. Will I need any additional medications or treatments to prevent or manage post-surgery bleeding while using ketorolac?
  7. How long will I be taking ketorolac for pain management, and what is the recommended dosage schedule?
  8. Are there any specific precautions I should take while using ketorolac, such as avoiding certain foods or activities?
  9. What follow-up appointments or monitoring will be necessary after my surgery to ensure my safety while using ketorolac for pain management?
  10. Are there any additional resources or information available to help me understand the use of ketorolac in managing pain after tonsillectomy?

Reference

Authors: Yadav D , Dangol B , Shrestha N , Pandit S , Nepal A . Journal: Kathmandu Univ Med J (KUMJ). 2023 Jan-Mar;21(81):3-6. PMID: 37800417