Retrospective Cohort Study of Ibuprofen Based Pain Regimen to Reduce Postoperative Opioid Use in Adult Tonsillectomy

Objectives: Quantify the effect of a non-opioid pain regimen on postoperative opioid prescriptions filled by the patient after adult tonsillectomy. Design: Retrospective cohort study including a time frame before and after a practice change from an opioid/acetaminophen-based postoperative pain regimen to a regimen based on ibuprofen and acetaminophen. Half of study subjects received a prescription for postoperative opioid medications. Half were prescribed ibuprofen following surgery and only provided with opioid analgesia as a rescue medication, where ibuprofen was medically contraindicated, or at patient request following counseling regarding risks of opioids. The New Mexico Prescription Monitoring System was used to verify filled opioid prescriptions. Descriptive statistics and logistic regression were used for data analysis. Settings: Tertiary care academic medical center. Participants: All elective adult tonsillectomies performed consecutively by a single surgeon. Main Outcome Measures: Percent of patients filling an opioid prescription. Results: Ninety-nine patients were included in analysis. 53 received an opioid-based postoperative regimen and 46 received an ibuprofen/acetaminophen-based regimen. There was no difference in the bleeding rate between the two groups. Significantly fewer patients in the ibuprofen group filled postoperative opioid prescriptions when compared to the group that did not receive ibuprofen (40% vs. 96.2%, p<0.0001, OR=0.02). Conclusion: Ibuprofen is a safe and effective analgesic following adult tonsillectomy and significantly reduces the proportion of patients who fill a postoperative opioid prescription.