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Video

Pediatric Otolaryngology

(A939) Opioid Free Pain Management in Young Children: Impact on Rates of Admission and Post-Tonsillectomy Hemorrhage

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • LC

    Lacey C. Cantrell, MD

    Resident
    Cleveland Clinic Foundation
    Cleveland, Ohio, United States

    • Co-Author(s)

  • Benjamin I. Wajsberg, MD

    PGY3
    Head and Neck Institute, Cleveland Clinic Foundation
    Cleveland, OH, United States

  • TW

    Tyler Weber, BS

    Cleveland Clinic Foundation, United States

    • Senior Author(s)

  • SA

    Samantha Anne, MD

    Medical Director, Pediatric Ear and Hearing Disorders; Professor, Pediatric Otolaryngology
    Cleveland Clinic Foundation
    Chagrin Falls, OH, United States

Disclosure(s):
Samantha Anne, MD: No relevant relationships to disclose.


Introduction: Reported rates in literature of post-tonsillectomy hemorrhage (PTH) are approximately 3-4% and physician contact ranges over 20%. Postoperative admissions and emergency room visits can be as high as 8%. Ibuprofen is shown to be efficacious in management of post-tonsillectomy pain with no increase in PTH rates. Opioids, on the other hand, have been associated with risks especially in young children. This study aims to evaluate postoperative physician contact, admissions, and PTH with opioid free pain management in children under age ten compared to rates reported in the literature.

Methods: This is a retrospective review of pediatric patients who underwent T&A with a single surgeon at a tertiary care center from 2020-2024. Children older than ten and who underwent partial tonsillectomy were excluded. Chart review included all physician contacts related to pain control, admissions, and PTH that required surgery, and opioids. Exact binomial 95% confidence intervals were determined for percentages, and logistic regression models were used to perform covariate-adjusted comparisons.

Results: A total of 417 patients were included; Only 20 (4.8%) were prescribed opioids. In the non-opioid group, readmission rate was 9.7% (95% CI 6.9-13.1%). PTH requiring surgical intervention was 3.4% (95% CI 1.8-5.8%). Rate of physician contact for pain control was 24.7% (95%CI 20.4 - 29.3%). In the opioid group, readmission rate was 17.6% (95%CI 3.8 - 43.4%). There was no PTH. Rate of physician contact was 17.6% (95% CI 3.8 - 43.4%). Using multivariate analysis adjusting for age, insurance and comorbidities, there was no statistically significant difference in number of readmissions, PTH, or physician contact among the groups. In addition, the rates in this study fall well within rates reported in literature.

Conclusions: Opioid free analgesia with acetaminophen and ibuprofen should be used for post tonsillectomy pain management in children under the age of ten. Opioid use should be discouraged, as use of opioids did not significantly decrease number of readmissions, surgical tonsil bleeds or need for postoperative physician contact.