From the Guidelines
Diabetes is associated with increased narcotic use after tonsillectomy, and patients with diabetes typically require higher doses of pain medications, including narcotics like morphine, hydrocodone, or oxycodone, following tonsillectomy procedures. This increased need for pain management may be due to diabetes-related neuropathy and altered pain perception pathways. Diabetic patients often experience more severe postoperative pain and may have delayed wound healing, which can prolong discomfort after surgery.
Key Considerations
- Healthcare providers should anticipate this increased analgesic requirement and may need to develop more aggressive pain management protocols for diabetic patients undergoing tonsillectomy 1.
- Close monitoring of blood glucose levels is essential during this period, as pain and narcotic medications can affect glycemic control.
- Providers should consider multimodal pain management approaches, including scheduled acetaminophen and NSAIDs (if not contraindicated), to potentially reduce the total narcotic requirement while still providing adequate pain relief for these patients 1.
Recommended Pain Management Approach
- A systematic review of randomised controlled trials published in the English language up to November 2019 assessing postoperative pain using analgesic, anaesthetic or surgical interventions was undertaken, and the results support the use of a multimodal analgesic approach for pain management after tonsillectomy 1.
- The analgesic regimen for tonsillectomy should include paracetamol, non-steroidal anti-inflammatory drugs, and intravenous dexamethasone, with opioids as rescue analgesics.
- Analgesic adjuncts such as intra-operative and postoperative acupuncture as well as postoperative honey are also recommended.
- Ketamine (only for children), dexmedetomidine, or gabapentinoids may be considered when some of the first-line analgesics are contraindicated.
Important Notes
- The concerns regarding the potential bleeding risk with the use of NSAIDs are not substantiated in recent studies, and most guidelines have been modified to recommend NSAIDs as a first-line treatment after tonsillectomy 1.
- Intra-operative acupuncture and postoperative honey are recommended as analgesic adjuncts, as they have been shown to provide superior pain relief when combined with paracetamol, NSAIDs, or oral opioids, with no reported side-effects.
From the Research
Association between Diabetes and Narcotic Use after Tonsillectomy
- There is limited direct evidence to suggest a correlation between diabetes and increased narcotic use after tonsillectomy 2, 3.
- A study on the impact of diabetes mellitus following tonsillectomy in adults found that patients with diabetes are at a heightened risk for complications, including prolonged hospitalization and reoperation 3.
- However, this study did not specifically investigate the relationship between diabetes and narcotic use after tonsillectomy.
- Another study found that ibuprofen prescription following adult tonsillectomy can reduce postoperative opioid use, but it did not examine the effect of diabetes on narcotic use 4.
- A review of nonopioid alternatives for acute pain management suggested that combination therapy using a small amount of opioid together with a nonopioid pain reliever can be effective, but it did not address the specific question of diabetes and narcotic use 5.
Postoperative Pain Management and Narcotic Use
- Studies have shown that non-steroidal anti-inflammatory medications, such as ibuprofen, can be a safe and effective way to reduce postoperative opioid use after tonsillectomy 4, 6.
- The use of discharge order sets with standardized analgesic medication regimens can also help reduce opioid prescribing practices after pediatric tonsillectomy 6.
- However, these studies did not investigate the relationship between diabetes and narcotic use after tonsillectomy.