Zusammenfassung
FRAGESTELLUNG: Ziel der Studie war es, den Einfluss der Operationstechnik auf die postoperative Morbidität und auf die systemische Entzündungsreaktion nach Tonsillektomien zu untersuchen. Hierzu wurden zwei Gruppen tonsillektomierter Kinder in Bezug auf die systemische Entzündungsreaktion, den postoperativen Schmerzgrad und die Dauer bis zum Erreichen einer normalen physiologischen Aktivität verglichen. Die Entzündungsparameter wurden in Relation zur postoperativen Morbidität gesetzt. PATIENTEN UND METHODEN: Die prospektive, randomisierte, einfach verblindete Studie umfasst 100 Kinder im Alter zwischen 3 und 16 Jahren, die in unserer Einrichtung wegen einer chronischen Tonsillitis und/oder Atemwegsobstruktion tonsillektomiert wurden. Die Kinder wurden in zwei Gruppen randomisiert. Die erste Gruppe erhielt eine konventionelle Tonsillektomie mit bipolarer Blutstellung. Die zweite Gruppe bekam eine radiofrequenz-unterstützte Tonsillektomie. Das Nachuntersuchungsintervall betrug 14 Tage. Folgende Parameter wurden untersucht: Intensität und Dauer der postoperativen Schmerzen (gemessen im Schmerzmittelbedarf in der postoperativen Phase), postoperativer Tag, an dem erstmals wieder normale physische Aktivität möglich war, und die Nachblutungsrate. Um die systemische Entzündung zu erfassen, wurden die Serumblutspiegel des C-reaktiven Proteins (CRP) unmittelbar vor der Operation und am siebten postoperativen Tag bestimmt. ERGEBNISSE: Es ergab sich eine statistisch signifikante Korrelation zwischen erhöhten CRP-Serumspiegeln und dem postoperativen Schmerzmittelbedarf und zwar sowohl für die Anzahl der Analgetikagaben (r = 0,28; p < 0,01) als auch für die Anzahl der Tage, an denen Analgetika benötigt wurden (r = 0,26; p < 0,01). Des Weiteren ergab sich eine Korrelation zwischen erhöhten CRP-Blutspiegeln und der verlängerten Dauer bis zum Erreichen einer unbehinderten körperlichen Aktivität (r = 0,30; p < 0,01). SCHLUSSFOLGERUNG: Die postoperative Morbidität nach Tonsillektomie scheint von der systemischen Entzündungsreaktion abzuhängen, die die Operation hervorruft. Die Entzündungsreaktion wiederum scheint von der Operationstechnik abzuhängen – eine weniger invasive Technik führt zu einer geringeren systemischen Entzündungsreaktion und zu einer geringeren postoperativen Morbidität.
Summary
AIMS: Investigate the influence of operative technique on post-operative morbidity and the systemic inflammatory response after tonsillectomy. In addition, our aim was to compare the systemic inflammatory reaction, post-operative pain severity, and required time before the resumption of normal physical activity between two groups of tonsillectomized children and to correlate characteristics of the systemic inflammatory reaction to post-operative morbidity. PARTICIPANTS AND METHODS: This prospective, randomized, and single-blind study included 100 children between the ages of 3–16 years and who were scheduled for a tonsillectomy at our department for chronic tonsillitis and/or respiratory obstruction. The children were randomly assigned into one of two groups: either a conventional tonsillectomy with bipolar diathermy coagulation or a radiofrequency tonsillectomy procedure; both groups had a 14-day follow-up. We investigated the severity and duration of postoperative pain (based on the use of analgesics during the postoperative period), the postoperative day that they resumed normal physical activity, and the rate of postoperative hemorrhage. In order to assess the systemic inflammatory response, serum C-reactive protein (CRP) levels were measured before the surgery and seven days after the procedure. RESULTS: After the surgery CRP levels increased to a statistically significant level (t = –4.7; p < 0.001) in conventional tonsillectomy group. There was a statistically significant correlation between increased blood CRP levels after the surgery and the level of post-operative analgesic consumption, which was based on an increased number of analgesic applications (r = 0.28; p < 0.01) and a greater number of days in which analgesics were consumed (r = 0.26; p < 0.01). There was also a correlation between increased blood CRP levels and a longer required time to resume normal physical activities (r = 0.30; p < 0.01). CONCLUSION: Post-operative morbidity after tonsillectomy appears to depend on the systemic inflammatory response to surgery. This response is "technique-related," wherein a less-aggressive surgical technique produces a weaker post-operative inflammatory response and less post-operative morbidity.
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Roje, Z., Racic, G., Kardum, G. et al. Is the systemic inflammatory reaction to surgery responsible for post-operative pain after tonsillectomy, and is it "technique-related"?. Wien Klin Wochenschr 123, 479–484 (2011). https://doi.org/10.1007/s00508-011-0020-1
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DOI: https://doi.org/10.1007/s00508-011-0020-1