Role of routine fluid replacement in children undergoing tonsillectomy

Abstract

It has been suggested that children undergoing tonsillectomy would benefit from an intravenous infusion, to counteract the period of pre-operative fasting combined with the blood loss at operation. A prospective study of 50 children undergoing tonsillectomy was undertaken. The children were randomly allocated into two groups, one to receive an infusion and a control group. There were no significant differences between the two groups, although the children with an infusion had a longer mean post-operative stay. There would seem to be no role for routine intravenous fluid replacement in children undergoing uncomplicated tonsillectomy.

A comparison of ibuprofen versus acetaminophen with codeine in the young tonsillectomy patient

“…Antibiotics administered intraoperatively and for 7 days after surgery have decreased pharyngeal pain dramatically and lessened the duration of the pain 11‐13 . Wilson et al 14 found no effect of intravenous hydration on postoperative pain. Concerning nonsteroidal antiinflammatory drugs (NSAIDs), their efficacy in relieving postoperative pain has been well documented, but their mechanism is not definitively known.…”

ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children— a systematic review and meta-analysis

“…It showed no significant difference in length of stay between enteral and parenteral hydration (mean difference = 9.09, 95% CI [−1.24–19.43], p = 0.08) (Fig. 2 ) but a trend towards a reduction in length of hospital stay in the enteral group [ 23 , 24 , 27 , 28 ].…”

The effect of preoperative fasting on postoperative thirst, hunger and oral intake in paediatric ambulatory tonsillectomy

“…However, it is worth mentioning that there were also children in both study groups who received almost no nutrition except the intravenous fluids during the 24 postoperative hours. Some former studies have shown that there is no role for routine intravenous fluid replacement in children undergoing uncomplicated tonsillectomy because dehydration leads to thirst and drinking (Wilson et al. 1990) However, uncomplicated tonsillectomy does not ensure the child’s proper oral intake after surgery and it seems to be a risk to leave the child without routine intravenous fluid replacement.…”

“…There is no need for fluid replacement, and children receiving intravenous fluids also have a longer postoperative stay in hospital. However, it is considered safe to discharge a child before normal oral intake (Wilson et al. 1990, Messner & Barbita 1997, Kearney et al.…”