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November 2016

Choice of Analgesics After AdenotonsillectomyAre We Between a Rock and a Hard Place?

Author Affiliations
  • 1Section of Otolaryngology-Head and Neck Surgery, The University of Chicago School of Medicine and the Comer Children’s Hospital, Chicago, Illinois
JAMA Otolaryngol Head Neck Surg. 2016;142(11):1041-1042. doi:10.1001/jamaoto.2016.3216

The following case of severe posttonsillectomy bleeding (PTB) caused us to ponder the current recommendations for posttonsillectomy pain management. A 6-year-old patient underwent adenotonsillectomy for obstructive sleep apnea. The patient was receiving 81 mg of aspirin owing to concern for microthrombi prior to and after surgery. Postoperatively, the patient was given ibuprofen for pain control. On postoperative day 8, severe hemorrhage from the right tonsillar fossa required emergent intubation, oropharyngeal packing, transfusion with 2 units of packed red blood cells, and transfer to our children’s hospital. The patient was hypotensive and tachycardic on arrival, necessitating transfusion of 2 more units of packed red blood cells and urgent posttonsillectomy coagulation in the operating room; recovery was uneventful.

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