Platelet-rich plasma for post-tonsillectomy pain, haemorrhage, and wound healing: a systematic review and meta-analysis of randomized controlled trials

Abstract Purpose To determine whether intraoperative autologous platelet-rich plasma (PRP) reduces postoperative pain and haemorrhage and enhances wound healing after tonsillectomy, while critically evaluating the limitations that affect clinical translation and future applications. Methods Five databases were searched through 3 July 2026 for randomized controlled trials comparing PRP with no PRP, placebo, or an untreated contralateral fossa. Risk of bias was assessed using RoB 2 and certainty using GRADE. Random-effects models with Hartung-Knapp adjustment were used for pain and healing outcomes; sparse haemorrhage outcomes were analysed using Mantel-Haenszel common-effect models with sensitivity analyses. Parallel-group and split-mouth trials were analysed separately. Results Twelve randomized trials including 723 patients were included, with 11 contributing quantitative data. PRP was associated with reduced pain on postoperative day (POD) 1 (MD -1.21, 95% CI -2.01 to -0.40) and POD 3 (MD -1.12, 95% CI -2.10 to -0.14), although effects were heterogeneous and transient. Primary haemorrhage showed a favourable common-effect estimate (RR 0.23, 95% CI 0.07–0.80), but this was based on only 12 events and was not confirmed by random-effects sensitivity analysis. Complete healing did not significantly differ between groups (RR 1.34, 95% CI 0.59–3.06). Conclusion PRP may provide a modest early analgesic effect after tonsillectomy, but current evidence does not demonstrate a consistent improvement in haemostasis or mucosal healing. Future research should focus on standardized PRP characterization, patient-level comparative trials, and direct evaluation of whether PRP improves tissue regeneration compared with other biomaterial-based approaches.