Post Tonsillectomy Bleeding among Children in a Tertiary Hospital in the Kingdom of Bahrain: Two Years Experience

Background: Palatine tonsils are part of the immune system located within the Waldeyer’s ring, they are prone to infections, hypertrophy or both. These conditions are known as tonsil diseases that usually require surgical removal through tonsillectomy. Tonsillectomy is one of the most common procedures done for children but it is challenged by the occurrence of complications, especially post tonsillectomy bleeding (PTB). In the current study, the incidence of post tonsillectomy bleeding in children younger than 14 years undergoing tonsillectomy in Salmaniya Medical Complex is evaluated and their demographic data and risk factors are assessed. Method: Pediatric patients who are younger than 14 years with postoperative tonsillectomy bleeding that were treated in Salmaniya Medical Complex between the period of January 2018 and December 2019 were retrospectively studied for risk factors. Results: A total of 1161 patients within the age range of 2 - 13 years old underwent tonsillectomy in Salmaniya Medical Complex from the period of January 2018 to December 2019. Twenty-eight pediatric patients had post-tonsillectomy bleeding (PTB) during the study period with an incidence of 2.4% of the total number of pediatric tonsillectomies done in our institute. The majority were male patients and the mean age was 6.2 years. The main indication of tonsillectomy for those with bleeding was recurrent tonsillitis. A second surgery was needed in 64.5% to control the bleeding. The size of the tonsil, the level of the surgeon and the season at which the tonsillectomy was done did not seem to have any effect on the incidence of post-tonsillectomy bleeding (PTB). Conclusion: The incidence of post tonsillectomy bleeding (PTB) in Salmaniya Medical Complex is 2.4%, which makes it a common complication for a common surgery irrelevant to any patient, surgeon or climate related factors.

Pharmacologic management of post-tonsillectomy pain in children

Tonsillectomy is a very common procedure in children,often performed on an outpatient basis.Severe postoperative pain is common,and can be prolonged.Despite a large number of available analgesic medications,often employed in combination,achieving adequate pain control remains a persistent challenge.Research suggests a tendency among caregivers to undertreat pain,and a need for detailed care instructions and education to ensure adequate pain management.Furthermore,ongoing questions regarding the safety and efficacy of the most commonly used medications have led to wide variance in practice patterns and continuous reassessment through research that yields sometimes conflicting results.This review summarizes the current state of the literature and presents a management approach which attempts to maximize pain control while minimizing potential harm with combinations of medications and modification based on patient-specific factors.