Comparative study of posttonsillectomy hemorrhage with the use of diclofenac versus dihydrocodeine for postoperative analgesia and review of the literature

Objective: To assess the effect of postoperative diclofenac on the posttonsillectomy hemorrhage rate in adults. Design: Retrospective chart review with Caldicott Guardian approval of patients before and after a change in the postoperative drug regimen. One hundred ninety-three adults between 16 and 56 years, American Society of Anesthesiologists Grade I, listed for elective tonsillectomy, were included in the analysis. Setting: A tertiary referral centre in the United Kingdom. Methods: One hundred ten adults had cold dissection tonsillectomy and had been prescribed soluble diclofenac postoperatively. This group was compared with 83 adult patients who underwent cold dissection tonsillectomy and had been prescribed dihydrocodeine solution postoperatively. Our hypothesis was that the postoperative use of diclofenac made no difference to the incidence of secondary hemorrhage. The Fisher exact test was used for analysis. Main Outcome Measures: Comparison of a previously reported posttonsillectomy hemorrhage rate with the rate for the year after the addition of diclofenac. The occurrence of primary or secondary postoperative hemorrhage and its management was recorded. Results: Three of 110 (2.73%) patients who used postoperative diclofenac had secondary hemorrhage compared with 6 of 83 (7.23%) of those patients treated with dihydrocodeine. The Fisher exact test for secondary hemorrhage therefore gives a p value of .131, and there is no significant difference. Conclusions: Diclofenac is a useful and safe addition to postoperative analgesia for adult tonsillectomy. There was an apparent reduction in secondary hemorrhage with the postoperative use of diclofenac. © 2008 The Canadian Society of Otolaryngology-Head & Neck Surgery