Abstract
Tonsillectomy is one of the most common surgical procedures performed worldwide. Several techniques have been developed to reduce morbidity and enhance recovery after tonsillectomy. Our study was designed to compare post-operative pain with three different techniques: cold dissection (CD), monopolar–bipolar dissection (MBD) and coblation dissection (CBD). 103 adults were scheduled for elective tonsillectomy from September 2014 to December 2015, and were randomized to CD, MBD and CBD. Post-operative pain was assessed using visual analogue scale (VAS) and Lattinen Test (LT). We did not find significant differences between the groups in the VAS pain scores (p > 0.05), except for the first day, when CBD tonsillectomy showed a higher pain score (p < 0.05). The differences in LT scores between the three techniques were not statistically significant (p > 0.05). Comparison of analgesic consumption between CD, MBD and CBD did not found any significant differences irrespective of the technique used. When first and second week after surgery were compared, differences in analgesics requirements were statistically significant (p < 0.05). Seventeen cases (16.5%) of secondary haemorrhage were reported, but there were no statistical differences in the rate of postoperative bleeding between the three groups (p > 0.05). We conclude that in our study comparison of the three techniques, CD, MBD and CBD, did not show significant differences in the post-tonsillectomy pain scores and bleeding rate.
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References
Jeffrey A (2002) On the origin of tonsillectomy and the dissection method. Laryngoscope 112:1583–1586
Silveira H, Soares JS, Lima HA (2003) Tonsillectomy: cold dissection versus bipolar electrodissection. Int J Pediatr Otorhinolaryngol 67:345–351
Ozkiris M, Kapusuz Z, Saydam L (2013) Comparison of three techniques in adult tonsillectomy. Eur Arch Otorhinolaryngol 270(3):1443–1447
Wilson YL, Merer DM, Moscatello AL (2009) Comparison of three common tonsillectomy techniques: a prospective randomized, double- blinded, clinical study. Laryngoscope 119(1):162–170
Darrow HD, Siemens C (2002) Indications for tonsillectomy and adenoidectomy. Laryngoscope 112:6–10
Hasan H, Raitiola H, Chrapek W, Pukenader J (2008) Randomized study comparing postoperative pain between coblation and bipolar scissor tonsillectomy. Eur Arch Otorhinolaryngol 265(7):817–820
Dutta N, Bordoloi BM (2002) Indian J Otolaryngol Head Neck Surg 54:74–76
Rakesh S, Anand TS, Payal C, Pranjal K (2012) A prospetive, randomized, double- blind study of coblation versus dissection tonsillectomy in adult patients. Indian J Otolaryngol Head Neck Surg 64(3):290–294
Wexler DB (1996) Recovery after tonsillectomy: electrodissection vs sharp dissection techniques. Otolaryngol Head Neck Surg 114:576–581
Maddern B (2002) Electrosurgery for tonsillectomy. Laryngoscope 112:11–13
Timms MS, Temple RH (2002) Coblation tonsillectomy: a double blind randomized controlled study. J Laryngol Otol 116:450–452
Belloso A, Chidambaran A, Morar P, Timms MS (2003) Coblation tonsillectomy versus dissection tonsillectomy: postoperative haemmorhage. Laryngoscope 113:2010–2013
Ragab SM (2012) Six years of evidence- based adult dissection tonsillectomy with ultrasonic scapel, bipolar electrocautery, bipolar radiofrequency or “cold steel” dissection. J Laryngol Otol 126(10):1056–1062
Leinbach RF, Markwell SJ, Colliver JA, Lin SY (2003) Hot versus cold tonsillectomy: a systematic review of the literature. Otolaryngol Head Neck Surg 129:360–364
Cardozo AA, Hallikeri C, Lawrence H, Sankar V, Hargreaves S (2007) Teenage and adult tonsillectomy: dose–response relationship between diathermy energy used and morbidity. Clin Otolaryngol 32:366–371
Polites N, Joniau S, Wabnitz D, Fassina R, Smythe C, Varley P, Carney AS (2006) Postoperative pain following coblation tonsillectomy: randomized clinical trial. ANZ J Surg 76:226–229
Temple RH, Timms MS (2001) Paediatric cobaltion tonsillectomy. Int J Pediatr Otorhinolaryngol 61:195–198
Lowe D, van der Meulen J (2004) Tonsillectomy technique as a risk factor for postoperative haemorrhage. Lancet 364:697–702
Hopkins C, Geyer M, Topham J (2003) Post- tonsillectomy haemorrhage: a 7-year retrospective study. Eur Arch Otorhinolaryngol 260:454–455
Tolska HL, Takala A, Pitkaniemi J, Jero J (2013) Post-tonsillectomy haemorrhage more common than previously described- an institutional chart review. Acta Otolaryngol 133:181–186
Betancourt AR, Lopez Z, Zerpa V, Carrasco M, Dalmau J (2015) Does surgical technique influence post-tonsillectomy haemorrhage? Our experience. Acta Otorrinolaringol Esp 66:218–223
Windfuhr JP, Wienke A, Chen YS (2009) Electrosurgery as a risk factor for secondary hemorrhage. Eur Arch Otorhinolaryngol 266:110–116
Praveen AC, Parthiban S, Terry RM (2013) High incidence of post- tonsillectomy secondary haemorrhage following coblation tonsillectomy. Indian J Otolaryngol Head Neck Surg 65:24–28
Mueller J, Boeger D, Buentzel J, Esser D, Hoffman K, Jecker P, Mueller A et al (2015) Population- based analysis of tonsil surgery and postoperative hemorrhage. Eur Arch Otorhinolaryngol 272(12):3769–3777
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This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Álvarez Palacios, I., González-Orús Álvarez-Morujo, R., Alonso Martínez, C. et al. Postoperative Pain in Adult Tonsillectomy: Is There Any Difference Between the Technique?. Indian J Otolaryngol Head Neck Surg 69, 187–193 (2017). https://doi.org/10.1007/s12070-017-1058-9
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DOI: https://doi.org/10.1007/s12070-017-1058-9