Managing Post-tonsillectomy Pain Without Narcotics

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The Division of Otolaryngology at Children’s Hospital of Philadelphia (CHOP) believes all children have a right to the best pain management that can be safely provided. Children will likely have pain after surgery and sometimes they will not be pain free, but each child will be made as comfortable as possible without the use of narcotics.

Physicians and researchers at CHOP recently completed a study seeking a safe and effective alternative to narcotic use after tonsillectomy. They studied the use of celecoxib (Celebrex®) for controlling pain without increasing the risk of bleeding after tonsillectomy. Celecoxib is a safe an effective nonsteroidal anti-inflammatory drug (NSAID), specifically a COX-2 inhibitor, that is approved for use in children ages 2 and older.

Celecoxib: Safe and effective alternative to narcotics

Celecoxib is available in capsules that children can swallow whole, or for younger children, the capsule can be opened and sprinkled in a teaspoon of water, pudding or yogurt. It is convenient for families as it is given twice a day, 12 hours apart. The child is prescribed celecoxib during the preoperative visit when a tonsillectomy is recommended. Families are instructed to give the first dose of Celecoxib one to two hours before their arrival for surgery. It is then given twice a day in combination with acetaminophen (Tylenol) for up to 10 days after tonsillectomy.

Prior to initiating the use of celecoxib after tonsillectomy, 81% of CHOP tonsillectomy patients were prescribed narcotics for pain control. With the use of celecoxib, the current narcotic prescribing rate has decreased to 5% with no increase in complications or readmissions after surgery. For those rare cases requiring narcotics, such as children under 2 years of age, the division instituted strict prescribing criteria, including limiting the dosing to a five-day supply.

Education updated to include celecoxib after tonsillectomy

The medical and nursing staff at CHOP’s Philadelphia hospital and ambulatory surgical facilities in the CHOP Care Network received education on the updated pain management protocols. Patient and family education materials were also updated to ensure an equitable experience for all patients and families. This includes information specifically on the use of celecoxib after tonsillectomy.

For families whose insurance may require a prior authorization for celecoxib, Otolaryngology nurses are dedicated to assisting families with this process. When a child is pain free and back to a normal diet and activities for 24 hours, it is OK for them to stop taking pain medication.

The results of the study revealed celecoxib was well tolerated by patients and did not increase the risk of bleeding after surgery. This provides children and youth with a safe and effective alternative to narcotics for use after tonsillectomy.

Tonsillectomies requiring an overnight inpatient stay are now available at CHOP’s King of Prussia Hospital.

To refer a patient to Otolaryngology at CHOP, call 215-590-3440.