Monopolar tonsillotomy versus cold dissection tonsillectomy in children: Prospective study on postoperative recovery

Sakki, Anniina J.; Mäkinen, Laura K.; Kanerva, Mari; Nokso-Koivisto, Johanna

doi:10.1016/j.ijporl.2020.110513

Cited by 13 publications

(13 citation statements)

References 42 publications

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“…In addition, some scholars suggested intracapsular tonsillectomy to reduce the PTH and pain 6,7 . However, others found that intracapsular tonsillectomy may result in regrowth of tonsillar tissue in patients with tonsillar hypertrophy and require revision surgery 8–11 . Thus, extracapsular tonsillectomy continues to be recommended in most of departments and our institution.…”

Section: Introductionmentioning

confidence: 99%

“… 6 , 7 However, others found that intracapsular tonsillectomy may result in regrowth of tonsillar tissue in patients with tonsillar hypertrophy and require revision surgery. 8 , 9 , 10 , 11 Thus, extracapsular tonsillectomy continues to be recommended in most of departments and our institution. The aim of this study was to compare the intraoperative blood loss, postoperative pain, PTH, and medical costs associated with extracapsular tonsillectomy between coblation and monopolar electrocautery in children.…”

Section: Introductionmentioning

confidence: 99%

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A prospective, randomized, single‐blind study comparing coblation and monopolar extracapsular tonsillectomy

Lou¹,

Lou

Tian³

et al. 2022

Laryngoscope Investig Oto

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Objective: The aim of this study was to compare intraoperative blood loss, postoperative pain, post-tonsillectomy hemorrhage (PTH), and medical costs associated with extracapsular tonsillectomy between coblation and monopolar electrocautery in children. Materials and methods:This study included 293 patients aged 6-15 years planned to undergo extracapsular tonsillectomy. Data on estimated blood loss, postoperative pain score, operation time, PTH, and the cost of disposable equipment were collected.Results: Coblation extracapsular tonsillectomy was associated with significantly lower mean pain scores than monopolar technique on postoperative days 1 (p <.001) and 2 (p = 0.02). However, the pain score was similar between the groups at all other time points. The monopolar group had a significantly shorter operation time compared to the coblation group (11.09 ± 7.53 vs. 17.12 ± 4.29 min, p <.001).Intraoperative estimated blood loss was not significantly different between the groups (p = .43).The cost of extracapsular tonsillectomy was significantly lower in the monopolar compared to the coblation group (US$ 28.18 vs. US$ 430.48, p <.001). PTH occurred in 17 patients (5.80%) and required a second surgery. Secondary PTH occurred in 6.16% (9/146) and 0.68% (1/147) of patients in the coblation and monopolar groups, respectively (p <.001). The PTH was significantly higher in the tonsillitis compared to in the tonsillar hypertrophy (12.37% vs. 2.55%, p = .002), However, the difference of PTH was not significant among mean pain scores subgroups. Of the 17 patients with PTH, the lower pole, middle portion, and upper pole were involved in 15 (88.24%), 2 (11.76%), and 0 cases, respectively.Conclusions: Coblation and novel monopolar electrocautery extracapsular tonsillectomy are associated with similar postoperative pain scores except on postoperative days 1 and 2. However, monopolar technique offers significant advantages over coblation method with less operative time, decreased secondary PTH, and cost.Level of Evidence: NA.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A prospective, randomized, single‐blind study comparing coblation and monopolar extracapsular tonsillectomy

Lou¹,

Lou

Tian³

et al. 2022

Laryngoscope Investig Oto

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“…Postoperative pain after tonsillectomy is an important matter, which is related to the functional recovery of the patient. A decrease in postoperative pain is known to promote an increase in oral intake [ 6 , 18 ], earlier return to school [ 19 ], and reduction in analgesic medications after tonsillectomy [ 20 ]. Significantly less pain associated with coblation than electrocautery was revealed during the five consecutive postoperative days.…”

Section: Discussionmentioning

confidence: 99%

Intrapatient Comparison of Coblation versus Electrocautery Tonsillectomy in Children: A Randomized, Controlled Trial

Choi

Ahn

Rhee

et al. 2022

JCM

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Many surgical instruments have been introduced and compared for safety and surgical efficiency in tonsillectomy. This study aimed to compare postoperative pain between coblation and conventional monopolar electrocautery tonsillectomy by intrapatient comparison in children. Thirty pediatric patients over six years of age undergoing tonsillectomies were enrolled. Coblation and electrocautery were used to remove both tonsils in one patient; one was removed by coblation and the other by electrocautery. The coblation side was randomly selected, and it was blinded to the patients. Each side’s daily pain scores were collected on the visual analogue scale (VAS) during ten postoperative days. On the day of surgery, 22 (73%) patients identified less pain on the coblation side, while others felt similar pain. The mean pain scores were significantly lower on the coblation side during the postoperative ten days (except for the 6th and 8th) than on the electrocautery side. The duration of severe pain (VAS > 5) was significantly shorter on the coblation side than on the electrocautery side (2.0 versus 3.7 days, respectively; p = 0.042). Coblation tonsillectomy induced less pain than electrocautery in pediatric patients; therefore, surgeons could choose the coblator as a surgical instrument for tonsillectomy to improve the pediatric postoperative quality of life.

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“…Especially the nighttime medication may be omitted at home, resulting in more severe pain the next morning. Second, the pain profiles are limited to 3 postoperative days, although prolonged pain is expected 21,27,32,33 . Because we intended to collect high‐quality data based on professional assessments and to ensure that the pain protocol is consistently followed, a pain profile after discharge is not described.…”

Section: Discussionmentioning

confidence: 99%

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

Gude

Geldermann

Georgevici

et al. 2021

Acta Anaesthesiol Scand

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Background The optimal pain therapy for children undergoing tonsillotomy remains unknown. Our aim was to evaluate a standard pain therapy including the alternating application of ibuprofen and paracetamol. Methods Pain intensity of 81 in‐patients after tonsillotomy aged 2–12 years was evaluated three times daily (mean observation 3.85 days) using the Children's and Infants’ Postoperative Pain Scale (CHIPPS) in children <5 years, or with the Faces Pain Scale‐Revised (FPS‐R) in older children. Parents completed the Parents’ Postoperative Pain Measure (PPPM‐D) in addition. Exceeding the cut‐off value in one of the scores implied the indication for an opioid rescue medication (RM). Endpoints were number of children with indication for the RM, course of pain, concordance between pain scales, and adverse events. Results Overall, 45.7% of children needed the RM either in the recovery room or on the ward. The rate of children having an indication for RM on the ward was 30.9%. The highest proportion of affected children was identified on the day of surgery (32.1%). Most indications were detected with the PPPM‐D only. A comparison with an earlier study showed less affected children compared to ibuprofen monotherapy on the day of surgery and the first postoperative day. Eleven children (13.6%) developed fever. Conclusion Although our pain therapy concept was effective from postoperative day 1 onwards, it needs improvement for the day of surgery. The overall concordance between the PPPM‐D and CHIPPS or FPS‐R was low. Fever might be a confounder for the pain intensity measurement with the PPPM‐D.

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Monopolar tonsillotomy versus cold dissection tonsillectomy in children: Prospective study on postoperative recovery

Cited by 13 publications

References 42 publications

A prospective, randomized, single‐blind study comparing coblation and monopolar extracapsular tonsillectomy

A prospective, randomized, single‐blind study comparing coblation and monopolar extracapsular tonsillectomy

Intrapatient Comparison of Coblation versus Electrocautery Tonsillectomy in Children: A Randomized, Controlled Trial

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

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