Comparison of Postoperative Pain and Appetite in Pediatric Patients Undergoing Monopolar Tonsillotomy and Cold Steel Tonsillectomy

Abstract

Objectives. Adenotonsillectomy (AT) is amongst the most widely performed pediatric surgeries in the United States (US) and the whole world. AT includes two major surgical techniques: total tonsillectomy (TT) and partial tonsillectomy (PT). Several studies have been conducted to evaluate the difference between TT and PT and assess the comparative effectiveness, benefits, and sequelae between both. In Lebanon, very few studies were done tackling this issue and assessing its sequelae on the pediatric population. Methods. A prospective study was conducted including pediatric patients aged between 2 and 9 years, who were admitted for partial tonsillectomy (PT) or total tonsillectomy (TT) in 2018. An estimated number of children included were 50: 25 patients underwent PT and 25 patients underwent TT. Patients were sent home on day 1 post-op with a questionnaire that evaluates the following over the first 10 days post-op: pain using the Wong–Baker Faces Pain Rating Scale and the “Parents Postoperative Pain Measure” (PPPM) questionnaire, and appetite using the visual analogue scale (VAS). Results. Patients in the PT group and in the TT group had no demographical differences in terms of age, BMI, exposure to smoking, area of living, and attending a day care center. Comparison between PT and TT revealed a significant difference in both pain and appetite scales. Patients who underwent PT had significantly lower PPPM scores on the 1st, 2nd, 4th, 5th, 6th, and 10th day after surgery compared to the TT patients. Further validation was revealed by the Wong–Baker Faces Pain Rating Scale, showing that the PT surgery group experienced significantly less postoperative pain compared to the TT surgery group. Assessing the appetite using the visual analogue scale favored PT over TT. Comparisons revealed that most PT patients returned to their normal eating habits starting at day 4 while this was applicable in the TT group at day 10. Postoperative pain improved from day 1 to day 10 in both surgical groups. Conclusion. In conclusion, the recovery process after the PT surgery causes less postoperative morbidity, thus an earlier return to normal activity compared to the TT. The patients of the latter group are affected by more pain and less appetite over the first 10 days after the surgery.

Correlation of zinc intake with hair zinc levels and appetite in children aged 2-3 years in Jakarta

“…In this study, mean of VAS score was 54,5 mm. When compared to the cut off from El Sayed Ahmad et al 21 study in pediatric patients of tonsillotomy which categorized between 40 and 70 mm as "acceptable appetite", the mean VAS score of this study can be said to be "acceptable appetite". The plausible mechanism for correlation between appetite score and hair zinc status as showed in Daniels et al 19 study if toddler is lack of appetite or food fussy, then they may eat fewer foods that are high in zinc, and zinc status could decreased.…”

Pain in children undergoing tonsillotomy with alternating ibuprofen and paracetamol ‐ a prospective observational study

“…Studies offering a pain profile in children after TO are limited and heterogenous. A recent study comparing pain after TE or TO reported median PPPM scores >6 until the first day after surgery, although children received only paracetamol which was given until the 4th postoperative day in more than 30% of patients 22 …”