Postoperative Pain in Adult Tonsillectomy: Is There Any Difference Between the Technique?

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 ( > 0.05), except for the first day, when CBD tonsillectomy showed a higher pain score ( < 0.05). The differences in LT scores between the three techniques were not statistically significant ( > 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 ( < 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 ( > 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.

Radiofrequency Ablation vs Electrocautery Blinded Randomized Trial: Impact on Clinically Meaningful Outcomes

“…Previous smaller studies have had mixed conclusions, with some reporting less postoperative pain with the radiofrequency ablation device, 9,10 while others have suggested that there is no significant difference in posttonsillectomy pain or hemorrhage when comparing by instrument. 2,11 A previously conducted meta-analysis of the literature concluded that there was inadequate evidence to determine whether radiofrequency ablation tonsillectomy is better or worse than other techniques and that large, well-designed randomized studies are needed. 5…”

“…It is unclear whether choice of instrumentation improves outcome or affects the postoperative burden of pain and adverse events in patients undergoing tonsillectomy. 2,[9][10][11][12][13][14][15] One such important outcome is return to normal activity, which is a measure that has been used in several studies examining outcomes following tonsillectomy. 9,12,[16][17][18][19][20] This measure has been defined in different ways, including return to work, school, and/or play.…”

Postoperative Opioid Prescribing and Consumption Patterns after Tonsillectomy

“…5 One of the most common surgical procedures performed in the United States is tonsillectomy, a procedure often associated with considerable amounts of postoperative pain. 6,7 However, it is unknown whether surgeons are prescribing appropriate amounts of narcotic after tonsillectomy or even the typical amount of narcotic that is needed. If surgeons are in fact overprescribing, the remaining narcotics in the patients' possession may lead to their storage of surplus without usage, sale for personal profit, or potential future unnecessary usage, with the latter 2 believed to contribute to the current opioid epidemic.…”

Is Diclofenac Gargle Effective in Alleviating Post-Tonsillectomy Pain in Adults?

“…In a study by Ozkiris et al, mean pain score with cautery method was significantly higher 12 than that compared to steel dissec on. However, another study which compared pain with monopolar cautery method with cold steel dissec on and cobla on dissec on 16 did not find any significant difference. We carried out tonsil surgery in all par cipants with bipolar cautery.…”