gms | German Medical Science

The tonsillectomy is still one of the most performed operations in ENT surgery. However bleeding after the procedure may become a severe problem which needs professional handling. Postoperative analgesia especially with NSAID (non-steroidal anti inflammatory drugs) like Voltaren disp.^® plays an important roll in clinical practice and is an often discussed topic.

Preparing for a prospective study we analysed 776 patients undergoing a tonsillectomy from 01/09 till 06/11 in our clinic. As excluding factors we defined the advanced tumor tonsillectomy, the tonsillotomy and a quitting of further clinical treatment before the 6th postoperative day (n=43). Personal data (age, gender), the moment of bleeding, the need of surgical intervention as well as the prescribed analgesia were compared in a table.

In 733 patients we found 64 bleedings from which 50% required surgical intervention (4.42%). A higher rate of postoperative bleeding could be seen at the age group from 21 to 30 years without any gender-related accumulation.

For analgesia after the procedure we used NSAID in a determinded scheme (mostly Voltaren disp.^® (Diclofenac) 3x1 tablet) as well as other pain killers on demand. An increased need of pain releasing drugs showed on the 2nd and 4th postoperative day. Specially concerning Voltaren disp.® we found a higher rate of primary bleeding (first 24 hours after the procedure) as well as a decreased rate of bleeding complications from the 2nd till 6th postoperative day.

More bleeding complications in patients aged 21 to 30 could be found in other studies as well incriminating a higher rate of incompliance in this age group. An increased demand of pain killers on the 2nd and 4th postoperative day requires a modulation of analgesic scheme. A stringent rate of primary bleeding is to be discussed as reasons for bleeding in the first 24 hours after the procedure can usually be found in operation techniques.