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A Randomized, Double-blind, Paired Control Study of Postoperative Pain

Matthew T. Lister, MD; Michael J. Cunningham, MD; Barry Benjamin, MD; Michael Williams, MD; Ann Tirrell, RN; Debra A. Schaumberg, ScD, OD, MPH; Christopher J. Hartnick, MD, MS (Epi)

Arch Otolaryngol Head Neck Surg. 2006;132:599-604.

Objective  To examine whether microdebrider intracapsular tonsillotomy (MT) results in less postoperative pain compared with electrosurgical extracapsular tonsillectomy (ET).

Design  Prospective, randomized, double-blind, matched pair, clinical trial.

Setting  Specialty care hospital.

Patients  Twelve male (48%) and 13 female (52%) children aged 5 to 15 years, with obstructive tonsillar hyperplasia were randomized to have one tonsil removed by MT and the other by ET.

Interventions  An angled endoscopic microdebrider was used to perform MT, and ET was performed by standard monopolar cautery technique. Parents and children were blinded to the side of MT and ET. Children rated the pain 0 to 5 by side using the Faces Pain Scale–Revised. Blinded data collection was via telephone daily for 2 weeks by a study nurse.

Main Outcome Measures  Primary: postoperative pain as recorded by Faces Pain Scale–Revised; secondary, presence or absence of otalgia and postoperative bleeding.

Results  Twenty-two children (88%) had tonsillectomy and adenoidectomy, while 3 children (12%) had tonsillectomy alone. On postoperative days 1 to 9, children reported significantly less pain on the MT side compared with the ET side (paired t test; P<.01). By postoperative days 10 to 14, the difference between sides disappeared. Twenty children (80%) reported otalgia, and it was always unilateral. For those children reporting otalgia, there was a 100% correlation between the side of otalgia and the side of ET. There was no posttonsillectomy bleeding among the 25 children.

Conclusion  Microdebrider intracapsular tonsillotomy is significantly less painful compared with electrosurgical ET in children undergoing surgical intervention for obstructive tonsillar hypertrophy.

Author Affiliations: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (Drs Lister, Cunningham, Benjamin, Williams, and Hartnick and Ms Tirrell), and Departments of Otology and Laryngology (Drs Lister, Cunningham, Benjamin, Williams, and Hartnick and Ms Tirrell) and Medicine and Ophthalmology (Dr Schaumberg), Harvard Medical School, Boston.

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