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

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.