Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims Tonsillectomy is a common operation and evidence suggests pain management is often suboptimal(1). PROSPECT recommendations for analgesia includes NSAIDs pre or intraoperatively(2); however, type of NSAID is not specified. IV ibuprofen has a more favourable safety profile than ketorolac(3) and comes pre-prepared for infusion, reducing risk of drug error(4). Evidence suggests IV ibuprofen is as efficacious as ketorolac for postoperative pain(5,6), although no studies were specific to tonsillectomy. This project aims to investigate whether intravenous ibuprofen is as effective as intravenous ketorolac for reducing postoperative pain and postoperative opioid use, following tonsillectomy.

Methods This is an observational study. Recovery staff completed a questionnaire for all patients undergoing tonsillectomy between January and October 2023. Data collected: • Type of intravenous NSAID used (Ibuprofen vs Ketorolac vs no NSAID) • Postoperative pain score • Use of postoperative fentanyl Chi-squared test compared pain severity. One-way ANOVA compared fentanyl use and pain scores.

Results 77 patients included: • Received no NSAIDS: n=8 • IV ketorolac: n=31 • IV ibuprofen: n=38 Pain severity most frequently reported was ‘no pain’, followed by ‘moderate pain’ across all groups. There was no significant difference in pain scores or fentanyl use between IV ibuprofen and IV ketorolac groups.

Conclusions This study suggests IV ibuprofen produces similar outcomes in postoperative pain and postoperative fentanyl use when compared to IV ketorolac. Given the favourable safety profile, IV ibuprofen should be considered as NSAID of choice for tonsillectomy patients. The study was limited by sample size. Further large-scale studies and cost analysis are needed.