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Postoperative Tonsillectomy Pain in Pediatric Patients
Electrocautery (Hot) vs Cold Dissection and Snare Tonsillectomy— A Randomized Trial
Desmond A. Nunez, FRCS(ORL);
Janice Provan, FRCS;
Michael Crawford, FFARCS
Arch Otolaryngol Head Neck Surg. 2000;126:837-841.
Objective To determine the effect of the method of tonsillectomy on postoperative pain in pediatric patients.
Design Prospective, randomized, single-blind, controlled clinical trial.
Setting A university pediatric hospital in Aberdeen, Scotland.
Patients A volunteer sample of 54 children, aged 3 to 12 years, with recurrent tonsillitis or symptomatic adenotonsillar hypertrophy. Two patients withdrew consent.
Interventions Twenty-six children underwent a nonelectrical (ie, cold) dissection tonsillectomy with cold steel instruments, 5 of whom also had adenoidectomy by curettage. Monopolar diathermy forceps were used for tonsillar bed hemostasis. Twenty-four children had electrocautery (ie, hot) dissection tonsillectomy, 7 of whom underwent adenoidectomy by curettage without a suction coagulator.
Main Outcome Measures Postoperative analgesic consumption, time to regain normal diet and activity levels, and complications.
Results Patients who underwent hot dissection tonsillectomy showed no difference in time to first drink or analgesic use within the first 24 postoperative hours compared with children undergoing cold nonelectrical dissection tonsillectomy. The hot dissection tonsillectomy group took 7.5 (95% confidence interval [CI], 1-14.1) more doses of analgesics than the cold dissection group over the next 12 days (P<.05). The hot dissection tonsillectomy group took 2.5 more days than the cold dissection tonsillectomy group to regain normal diet (P<.05). Thirteen children (54%; 95% CI, 34-74) in the hot dissection tonsillectomy group and 6 (23%; 95% CI, 7-39) in the cold dissection tonsillectomy group sought outpatient care for throat pain, otalgia, poor diet, pyrexia, and/or bleeding (P<.05). Throat pain delayed in onset or of prolonged duration affected 9 children (38%; 95% CI, 19-57) in the hot dissection tonsillectomy group as opposed to 3 children (12%; 95% CI, 0-24) in the cold dissection tonsillectomy group (P<.05).
Conclusion Hot dissection tonsillectomy increases morbidity in pediatric patients in the recovery period following hospital discharge.
From the Departments of Otolaryngology (Drs Nunez and Provan) and Anaesthesia (Dr Crawford), The Royal Aberdeen Children's Hospital, Aberdeen, Scotland. Dr Crawford is now with the Department of Anaesthesia, Hairhmyres Hospital, East Kilbride, Scotland.
The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.
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