Celecoxib as a non-inferior alternative to ibuprofen in post-tonsillectomy pain and bleeding control

Introduction Post-tonsillectomy pain represents the major morbidity of the procedure, contributing to poor oral intake, dehydration, and hemorrhage. Ibuprofen, a non-selective cyclooxygenase (COX) inhibitor, is commonly used for post-operative analgesia but demonstrates potent platelet inhibition. Celecoxib, a selective COX-2 inhibitor, preserves platelet function while providing anti-inflammatory and analgesic effects. Pediatric use remains limited. Objectives To evaluate celecoxib postoperative outcomes as comparable to ibuprofen regarding pain, dehydration, and hemorrhage in pediatric tonsillectomy patients. Methods An IRB-approved retrospective cohort study of tonsillectomies performed between January 1 to December 31, 2024 and treated with ibuprofen or celecoxib. Patients ≤18 years old who underwent tonsillectomy were identified using CPT® codes 42820, 42821, 42825, and 42826. Exclusion criteria included prior tonsillar surgery, concomitant procedures other than adenoidectomy, bleeding disorders, and opioid or alternative NSAID use. Patients were grouped by immediate post-operative analgesic regimen: celecoxib or ibuprofen. Outcomes included postoperative pain, dehydration, hemorrhage, and reoperation for bleeding. Results A total of 1144 patients were included (celecoxib N = 157, ibuprofen N = 987). Overall complication rates were 3.2% in the celecoxib group and 7.1% in the ibuprofen group. No statistically significant differences were observed in pain (RR, 0.27; 95% CI, 0.04-2.01), dehydration (RR, 1.72; 95% CI, 0.48-6.08), hemorrhage (RR, 0.30; 95% CI, 0.07-1.22), or return to the operating room (RR, 0.35; 95% CI, 0.05-2.60). Conclusion Celecoxib demonstrated post-operative safety outcomes comparable to ibuprofen. Some parents noted practical benefits. It may represent a safe non-opioid alternative for pediatric tonsillectomy pain management.