Even though pediatric tonsillectomy is a well accepted treatment for upper airway obstruction or recurrent tonsillar infection, the painful recovery of this operation is unwelcome. As more studies are published on the beneficial effects of tonsillectomy, the number of tonsillectomies performed is likely to increase. It would behoove any surgeon performing this operation to be aware of the available options for post/perioperative pain control.New techniques used to perform tonsillectomy, innovative adjuvant medical therapy and other tools are reviewed.The search for 'the painless tonsillectomy' continues. Finding a technique that works best for each surgeon is paramount to successful tonsillectomy. Patient comfort, surgical time, complications such as bleeding and regrowth of tonsillar tissue, or recurrence of symptoms that lead to the initial operation should all be considered in the surgeon's choice of a particular tonsillectomy technique. Medical therapies such as corticosteroids in the perioperative period are well accepted as a pain adjuvant. Newer adjuvants include the use of pretonsillectomy injection of mixtures that include local anesthetics with opioids and clonidine. The use of nonsteroidal antiinflammatory drugs appears to be helpful for pain, but controversial regarding bleeding. Another successful strategy used to decrease pain perception is distraction.