Safety and Efficacy of Ibuprofen-Based Multimodal Analgesia for Adult Tonsillectomy

Saturday, September 28, 2024

10:24 AM – 10:30 AM EDT

Location: MBCC, 206

Disclosure(s):

Daniel L. Blumenthal, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

James D. Johns, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Jonathan P. Giurintano, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Although non-steroidal anti-inflammatory drugs (NSAIDS) have proven to effective for postoperative analgesia in other otolaryngologic procedures, use for adult tonsillectomies remains controversial.

Methods: This was a retrospective review of 373 patients who underwent adult tonsillectomy at Medstar Georgetown University Hospital and Medstar Washington Hospital Center between January 2017 and December 2023. Of those, 39 patients received multimodal analgesia with ibuprofen, while the other 334 received narcotic based medications without ibuprofen. Chi square, Fisher’s exact test, Kruskal Wallis, and unpaired T tests were used to assess any differences between the groups.

Results: Patients receiving ibuprofen required less morphine milliequivalents (MME) than those without ibuprofen after their initial prescription (297.4 vs 209.6, p < 0.001) and after all refills (352 vs 226.6, p < 0.001). 22.8% of patients without Ibuprofen requested refills compared to 7.7% of patients with Ibuprofen (p = 0.03). NSAID-based therapy was associated with fewer calls regarding postop pain (18.3% vs 5.1%, p = 0.04). There was no difference in total bleed rate, overall return to the operating room, return to the emergency department, or readmission. Among those that bled, patients on ibuprofen were more likely to require return to the OR to obtain hemostasis (p = 0.03). The combination of NSAIDs and steroids were superior to either drug alone at reducing total MME after tonsillectomy (p < 0.001).

Conclusions: Ibuprofen based multimodal analgesia is an effective method at reducing total MME needed for adult tonsillectomy patients. While there is no increased risk for bleeding, those that do bleed are more likely to require return to the operating room.

Presenting Author(s)

DB

Daniel L. Blumenthal, MD

Resident Physician
Georgetown University Hospital
Washington, DC, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Varsha Harish, BS

Medical Student
Georgetown University Medical School
Washington, DC, United States

Disclosure information not submitted.
James D. Johns, MD

Resident Physician
Medstar Georgetown University Hospital
Washington, District of Columbia, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Jackson R. Randolph, MD

Resident Physician
Medstar Georgetown University Hospital
Washington, DC, United States

Disclosure information not submitted.
Jonathan P. Giurintano, MD

Assistant Professor
MedStar Georgetown University Hospital
Washington , DC, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

MP

Matthew L. Pierce, MD

Director, Head and Neck Oncology
Medstar Georgetown and Washington Hospital Center
Washington, DC, United States

Disclosure information not submitted.