title: Comparative study of posttonsillectomy hemorrhage with the use of diclofenac versus dihydrocodeine for postoperative analgesia and review of the literature.
abstract: OBJECTIVE
  To assess the effect of postoperative diclofenac on the posttonsillectomy hemorrhage rate in adults.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Otolaryngology, Ninewells Hospital and Medical School, Dundee, Scotland. simon.mckean@nhs.net
authors.forename: Simon A
authors.initials: SA
authors.lastname: McKean
authors.forename: Michael S W
authors.initials: MS
authors.lastname: Lee
authors.forename: S S M
authors.initials: SS
authors.lastname: Hussain
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D003061:Codeine / Q000009:adverse effects / Q000031:analogs & derivatives*; D004008:Diclofenac / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D012189:Retrospective Studies; D014068:Tonsillectomy; D014069:Tonsillitis / Q000601:surgery
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; C014481:dihydrocodeine; D003061:Codeine