A single‐centre change of practice audit of pain after coblation intracapsular tonsillectomy compared to standard dissection tonsillectomy in a discrete pediatric population

Abstract

A single-centre change of practice audit of pain after coblation intracapsular tonsillectomy compared to standard dissection tonsillectomy in a discrete pediatric population.

Intracapsular Tonsillectomy Using Plasma Ablation Versus Total Tonsillectomy: A Systematic Literature Review and Meta‐Analysis

“…The included studies consisted of 3 RCTs using a with‐in patient design, 29 , 30 , 38 5 RCTs using a between‐patient design, 32 , 33 , 34 , 41 , 45 1 prospective cohort study, 40 and 8 retrospective cohort studies. 31 , 35 , 36 , 37 , 39 , 42 , 43 , 44 Across the 17 studies, a total of 1996 patients underwent CIT. The comparator arms included total tonsillectomy using plasma ablation (9 studies, 29 , 30 , 31 , 34 , 35 , 36 , 40 , 41 , 43 n = 1100), electrocautery (4 studies, 32 , 33 , 38 , 45 n = 155), cold steel (2 studies, 37 , 44 n = 77), electrocautery or plasma ablation (1 study, 42 n = 1800), any nonplasma ablation device (1 study, 35 n = 1216) and nondefined device (1 study, 39 n = 217).…”

“…Eleven studies included pediatric patients, 30 , 31 , 32 , 33 , 34 , 36 , 39 , 40 , 41 , 42 , 44 3 included both adults and pediatric populations, 37 , 43 , 45 2 studies included adult patients, 29 , 38 and 1 did not report on age. 35 The primary indication for all tonsillectomy procedures was obstructive (without history of recurrent infective indications) in 6, 32 , 33 , 34 , 37 , 39 , 45 infective in 2, 29 , 30 and mixed obstructive and/or infective in 7 studies.…”

“… 35 The primary indication for all tonsillectomy procedures was obstructive (without history of recurrent infective indications) in 6, 32 , 33 , 34 , 37 , 39 , 45 infective in 2, 29 , 30 and mixed obstructive and/or infective in 7 studies. 36 , 38 , 40 , 41 , 42 , 43 , 44 One study determined surgical procedure based on indication, with patients receiving CIT for obstructive indications without a history of recurrent tonsillitis and total tonsillectomy with a history of recurrent tonsillitis. 31 One study did not identify indication for surgery.…”

Day‐case paediatric tonsillectomy: why is there still a debate?

“…Secondary haemorrhage occurs from 48 h to 2 weeks and is often caused by infection within the tonsillar bed; this is largely irrelevant to the day surgery vs. inpatient debate as the child would already be home, whether their surgery had been undertaken via a day or inpatient pathway. Surgical technique such as the use of coblation rather than dissection has been shown to significantly reduce the incidence of postoperative haemorrhage and has the added benefit of reduced postoperative pain and earlier return to school [10][11][12]. Additional safety measures to mitigate against morbidity due to postoperative haemorrhage include the surgeon reviewing the child to assess for any bleeding before discharge and ensuring that if there are other siblings in the family home, a second adult is immediately available in the unlikely event of the child needing to return to hospital.…”

“…Surgical technique such as the use of coblation rather than dissection has been shown to significantly reduce the incidence of postoperative haemorrhage and has the added benefit of reduced postoperative pain and earlier return to school [10–12]. Additional safety measures to mitigate against morbidity due to postoperative haemorrhage include the surgeon reviewing the child to assess for any bleeding before discharge and ensuring that if there are other siblings in the family home, a second adult is immediately available in the unlikely event of the child needing to return to hospital .…”