Pre and Post-Operative Instructions Tonsillectomy

Pre-Operative Instruction for Tonsillectomy

Follow instructions from anesthesia/same day surgery personnel regarding eating or drinking prior to surgery. The surgery center or hospital will give the patient instructions regarding the time to show up for the procedure.

The patient will need tom remain without food or drink after midnight before the day of the procedure.

Avoid use of over the counter medications unless authorized by your surgeon.

Do not take Advil and all ibuprofen-type medications including Aleve, Relafen, Flexeril, and Motrin. Avoid Aspirin and all aspirin containing drugs.

Post Operative Care Instructions Following Tonsillectomy



The following instructions will help you know what to expect in the days following surgery. Do not, however, hesitate to call if you have any questions or concerns.Most children require seven to ten days to recover from the surgery. Adults may take longer to recover. Generally speaking, the younger the age, the faster the recovery with less associated pain.



Snoring, Runny, or Stuffy Nose can occur after surgery and last for about 2 weeks: This is normal and will resolve with the healing process. Normal saline nasal spray can be used. Occasionally, younger patients may have some changes in voice due to the removal of adenoid tissue. They sometimes sound more nasal. This usually will return to normal within four weeks.

Bad Breath

It is very common for patients to get bad breath for several weeks. The back of the throatwill change with healing. Do not be concerned if the throat appears white and foamy. The patient can brush their teeth, but gargling and mouthwash are not recommended. Coughing and throat cleaning may be done gently.

Nausea

Some patients experience nausea and vomiting after the surgery caused by the general anesthetic. This usually occurs within the first 24 hours and resolves on its own. A swollen uvula touching the base of the tongue may cause nausea. Keeping the patient in an upright position will help relieve the nausea caused by swollen uvula. Narcotic pain medications (such as Lortab or hydrocodone) may cause nausea and/or vomiting. Taking this medication after drinking or eating may decrease the chance of nausea and/or vomiting.

Physical Activities

After tonsillectomy, patients should rest. Most adults start transitioning into their daily routines after about 7-10 days. Heavy lifting should be avoided for 3-4 weeks. Children usually start playing after about 3-4 days and will tend to regulate their activity depending on how they feel. Strenuous physical activity is discouraged. Children may return to school whenever comfortable; a week is average, but 10 days is not unusual.  Travel away from home is not recommended for two weeks following surgery.

Diet

The more the patient drinks, the sooner the pain will subside. Water, apple juice, grape juice, and Gatorade are excellent sources of liquid. Soft foods such as ice cream, sherbet, yogurt, pudding, apple sauce and jello, should also be encouraged. Other soft, easily chewed foods are also excellent such as eggs, flaky baked fish, tofu etc. Avoid hot or spicy foods, or foods that are hard and crunchy. Carbonated beverages (Sprite, Coke, Pepsi etc.) and acidic beverages (orange juice atc.) may cause pain.



Contact your physician if there are signs of dehydration (urination less than 2-3 times a day or crying without tears).



MINIMUM Fluid Intake for the First 24 Hour Period is calculated by weight:



Weight of Patient         Minimal Fluid Intake



Over 20 Pounds             34 Ounces



Over 30 Pounds             42 Ounces



Over 40 Pounds             50 Ounces



Over 50 Pounds             58 Ounces



Over 60 Pounds             68 Ounces

 

Pain

Nearly all patients undergoing a tonsillectomy will have mild to severe pain in the throat after surgery. For the first several days (occasionally up to 10 days) following surgery this is expected. This can usually be controlled with Liquid Tylenol (acetaminophen). Avoid medication containing aspirin, ibuprofen, or other anti-inflammatory medication, for 2 weeks. Pain is often worse at night and may prompt the need for additional pain medication such as narcotic based medication like Lortab or Tylenol with Codeine. Ear pain, especially with swallowing is also a common occurrence; it is not an ear infection but due to referred pain from the surgery. (because stimulation of the same nerve that goes to throat also travels to the ear), and a few may incur pain in the jaw and neck. Treat it with Tylenol. Occasionally a stiff neck may occur. Please call if it becomes excessively painful.



Ice Collar / Warm Compress

An ice collar can be helpful for post operative sore throat. Make this by placing ice cubes and water in a large Zip-Loc bag and wrapping it in a towel. Gently lay the ice pack on the front of the neck. For neck pain, a hot-water bottle can be used to apply to the neck.

Fever

A low-grade fever (less than 101 degrees) following surgery may occur and should be treated with Tylenol (acetaminophen). Follow the directions on the bottle. While patients have a fever, they should play quietly or remain in bed. If the fever persists (more than two days) or if the temperature is higher than 102 and cannot be controlled with Tylenol, please contact the office. It is important that the patient drink plenty of fluids after surgery. This helps the healing process and helps reduce the chance of fever.call. Fever may indicate that the patient has not taken in sufficient fluids or may have an infection.



Bleeding

Post-operative bleeding is unusual, but it can occur up to 2 weeks after surgery. Most bleeding is minor and you may only see a little coating of blood on the tongue. Put the patient into bed, sitting upright, and place an ice collar on their neck. Watch for spitting, coughing, or vomiting of blood. With the exception of small specks of blood from the nose or in the saliva, bright red blood should not be seen. If such bleeding occurs, contact your physician immediately or take your child to the emergency room.



Scabs: A scab will form where the tonsils and adenoids were removed. These scabs are thick, white, and cause bad breath. This is not unexpected. Most scabs fall off in small pieces five to ten days after surgery and are swallowed. It is common for the pain to increase for a few days when the scab on the tonsillar area falls off. You may notice a small amount of blood when this occurs.

Follow up

Arrange to see us 4 to 6 weeks after surgery.