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Russo E, Festa BM, Costantino A, Bernardocchi A, Spriano G, De Virgilio A. Postoperative Morbidity of Different Tonsillectomy Techniques: A Systematic Review and Network Meta-Analysis. Laryngoscope 2024; 134:1696-1704. [PMID: 37843298 DOI: 10.1002/lary.31116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/31/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To compare different tonsillectomy techniques in terms of postoperative bleeding incidence and postoperative pain. METHODS An arm-based network analysis was conducted using a Bayesian hierarchical model. The primary and secondary outcomes were postoperative bleeding incidence and mean postoperative pain score. RESULTS A total of 6464 patients were included for five different interventions (cold dissection tonsillectomy; extracapsular coblation tonsillectomy; intracapsular coblation tonsillectomy [ICT]; bipolar diathermy tonsillectomy [BDT]; monopolar diathermy tonsillectomy). ICT showed the lowest absolute risk (4.44%) of postoperative bleeding incidence (73.31% chance of ranking first) and the lowest mean postoperative pain score (1.74 ± 0.68) with a 94.0% chance of ranking first, whereas BDT showed both the highest absolute risk of bleeding incidence (10.75%) and the highest mean postoperative pain score (5.67 ± 1.43). CONCLUSIONS ICT seems to offer better postoperative outcomes, in terms of reduced risk of bleeding and reduced pain. Further prospective studies are advised to confirm these findings. LEVEL OF EVIDENCE NA Laryngoscope, 134:1696-1704, 2024.
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Affiliation(s)
- Elena Russo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Alice Bernardocchi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
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Yun JH, Jang JY, Shin YS, Kim HJ, Kim CH, Park DY. Effect of monopolar diathermy power settings on postoperative pain, wound healing, and tissue damage after tonsillectomy: a randomized clinical trial. Sci Rep 2024; 14:267. [PMID: 38167450 PMCID: PMC10761731 DOI: 10.1038/s41598-023-50633-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
This study aimed to assess the impact of varying monopolar diathermy power settings on postoperative pain, hemorrhage, and wound healing following tonsillectomy. A single-center, prospective, randomized, double-blinded, controlled clinical study was conducted. During bilateral tonsillectomy procedures, one tonsil received low-power settings (15 W, cutting/blend) while the other tonsil received high-power settings (35 W, cutting/blend). Postoperative pain scores (0-10) and wound healing scores (0-3) were evaluated immediately after surgery and at 1, 2, and 4 weeks postoperatively using the visual analog scale. Additionally, histological analysis was performed on electrically resected tonsil tissues to assess tissue damage in the tonsil bed. The allocation of high and low power settings to each side was randomized. Results showed that 1 week after the surgery, the high-power group experienced significantly higher pain scores (mean ± standard deviation: 4.84 ± 2.21) compared to the low-power group (3.56 ± 2.24, p = 0.049). Moreover, the high-power side exhibited slower wound healing during the initial 1-2 weeks postoperatively, as indicated by lower wound scores at 2 weeks (high-power: 1.96 ± 0.64; low-power: 2.43 ± 0.59, p = 0.008). Furthermore, histological analysis revealed significantly deeper tissue degradation on the high-power side compared to the low-power side (p < 0.001), with mean depths of 565.2 ± 291.0 µm and 156.0 ± 36.8 µm, respectively. In conclusion, these findings suggest that when employing monopolar diathermy in tonsillectomy, lower power settings can lead to improved outcomes in terms of postoperative pain, wound healing, and tissue damage.Trial registration: CRIS identifier: KCT0005670 (cris.nih.go.kr, registration date: 11/12/2020).
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Affiliation(s)
- Ju Hyun Yun
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Jeon Yeob Jang
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Yoo Seob Shin
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Hyun Jun Kim
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
- Sleep Center, Ajou University Hospital, Suwon, Republic of Korea
| | - Chul-Ho Kim
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Do-Yang Park
- Department of Otolaryngology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea.
- Sleep Center, Ajou University Hospital, Suwon, Republic of Korea.
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Bhankhodia BP, Aiyer RG, Raval JB. Comparative Study of CO 2 LASER Assisted and Electrocautery Assisted Tonsillectomy with Conventional Tonsillectomy. Indian J Otolaryngol Head Neck Surg 2022; 74:5324-5328. [PMID: 36742541 PMCID: PMC9895544 DOI: 10.1007/s12070-021-02381-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/05/2021] [Indexed: 02/07/2023] Open
Abstract
Tonsillectomy is the most common surgical procedure performed since many years. Various methods of tonsillectomy (Electrocautery, LASER, Harmonic scalpel, Coblation) have been practiced over the last century aiming for reducing intra and postoperative morbidity. We carried out prospective randomized control study using retrospective data as secondary data to compare blood loss, excision and hemostasis time, pain, recovery time and complication between CO2 LASER and Electrocautery assisted with conventional method. Average time for surgery with CO2 LASER (82.17 min) was more than conventional (77.77 min) and electrocautery (21.40 min) was least. The postoperative pain and recovery time was more in CO2 LASER and Electrocautery group than conventional. The blood loss was more in conventional group compared to other two group. We concluded that CO2 LASER group has longest operative time but least blood loss. Postoperative pain was more and lasted longer in Electrocautery group. Conventional method had least recovery time, least tissue reaction and least hospital stay.
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Affiliation(s)
| | - R. G. Aiyer
- Department of E.N.T., Medical College Baroda, Vadodara, Gujarat, India
| | - Jayman B. Raval
- Department of E.N.T., Medical College Baroda, Vadodara, Gujarat, India
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Greenwell AG, Isaiah A, Pereira KD. Recovery After Adenotonsillectomy-Do Steroids Help? Outcomes From a Randomized Controlled Trial. Otolaryngol Head Neck Surg 2020; 165:83-88. [PMID: 33228459 DOI: 10.1177/0194599820973250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The primary objective was to compare pain control following adenotonsillectomy (AT) in children with and without a single postoperative dose of oral dexamethasone in addition to standard analgesic medication. The secondary objective was to compare changes in caregiver-reported snoring, return to normal diet and baseline function, and the number of phone calls and emergency department (ED) visits. STUDY DESIGN Prospective randomized controlled trial. SETTING Tertiary care university hospital. METHODS Children aged 3 to 10 years with sleep-disordered breathing who were scheduled to undergo AT were randomized to receive standard analgesia with or without dexamethasone (0.6 mg/kg) administered on the third postoperative day. Standard analgesia was defined as alternating weight-based doses of ibuprofen and acetaminophen. A nurse practitioner blinded to the study condition performed telephone surveys postoperatively, and the electronic medical record was reviewed. RESULTS Enrollment comprised 149 children, of whom 119 were included. When compared with the control group (n = 61, 51%), children who received dexamethasone (n = 58, 49%) had a greater decrease in reported pain score on day 4 (mean ± SD, 2.5 ± 3.1 vs 1.1 ± 3.5, P < .001). Additionally, steroid use was associated with fewer caregiver phone calls (18 [29.5%] vs 6 [10%]) and ED visits (6 [10%] vs 1 [2%]). CONCLUSION A single dose of dexamethasone administered on day 3 after adenotonsillectomy significantly improved pain control. There were fewer phone calls and ED visits in the steroid arm. These results support the use of oral steroids as an adjunct for postoperative pain control in children undergoing AT.
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Affiliation(s)
- Ariana G Greenwell
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Kevin D Pereira
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
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5
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Prussin AJ, Babajanian E, Error M, Grimmer JF, Ku J, McRae B, Meier J, Thiesset H, Skirko JR. Radiofrequency Ablation vs Electrocautery Blinded Randomized Trial: Impact on Clinically Meaningful Outcomes. Otolaryngol Head Neck Surg 2020; 164:1186-1192. [PMID: 33079009 DOI: 10.1177/0194599820964737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze patients' return to normal activity, pain scores, narcotic use, and adverse events after undergoing tonsillectomy or adenotonsillectomy with monopolar electrocautery or radiofrequency ablation. STUDY DESIGN Randomized double-blinded clinical trial based on prospective parallel design. SETTING Academic medical center and tertiary children's hospital between March 2018 and July 2019. METHODS Inclusion criteria included patients aged ≥3 years with surgical indication of recurrent tonsillitis or airway obstruction/sleep-disordered breathing. Patients were randomly assigned to monopolar electrocautery or radiofrequency ablation. Patients were blinded to treatment assignment. Survey questions answered via text or email were collected daily until postoperative day 15. The primary outcome was the patient's return to normal activity. Secondary outcomes included daily pain score, total amount of postoperative narcotic use, and adverse events. RESULTS Of the 236 patients who met inclusion criteria and were randomly assigned to radiofrequency ablation or monopolar electrocautery, 230 completed the study (radiofrequency ablation, n = 112; monopolar electrocautery, n = 118). There was no statistically significant difference between the groups in the number of days for return to normal activity (P = .89), daily pain scores over 15 postoperative days (P = .46), postoperative narcotic use (P = .61), or return to hospital for any reason (P = .60), including bleeding as an adverse event (P = .13). CONCLUSIONS As one of the largest randomized controlled trials examining instrumentation in tonsillectomy, our data do not show a difference between monopolar electrocautery and radiofrequency ablation with regard to return to normal activity, daily pain scores, total postoperative narcotic use, or adverse events.
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Affiliation(s)
- Aaron J Prussin
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Eric Babajanian
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Marc Error
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - J Fredrik Grimmer
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Jessica Ku
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Bryan McRae
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Jeremy Meier
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
| | - Heather Thiesset
- Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
| | - Jonathan R Skirko
- Division of Otolaryngology, University of Utah Health, Salt Lake City, Utah, USA
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Al-Shehri AMS, Alenzi HLS, Ali Mohammed YM, Musleh A, Bharti RK, Saeed Munshet AM. Cauterization tonsillectomy as compared to traditional tonsillectomy technique. J Family Med Prim Care 2020; 9:3981-3985. [PMID: 33110797 PMCID: PMC7586625 DOI: 10.4103/jfmpc.jfmpc_84_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/12/2020] [Accepted: 05/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Tonsillectomy is one of the most frequently applied and oldest surgical procedures in otorhinolaryngology. Various surgical techniques are used to perform this operation including traditional and cauterization techniques. Objectives: To assess morbidity and efficacy and compare objectively the techniques in tonsillectomy, i.e., traditional technique and cauterization technique. This study compares the traditional and cauterization tonsillectomy techniques in view of their advantages and complications. Methods: This is a retrospective study and comparative study, conducted during the period from January 2017 to March 2018 from the patients attending to Alnamas General Hospital, Aseer Region, Saudi Arabia. The questionnaire was designed to compare the traditional and cauterization tonsillectomy. Fifty patients underwent traditional technique and fifty patients underwent cauterization method. The data analyzed using SPSS V.16.0 (SPSS Inc; Chicago, IL, USA). Results: A total of 100 patients, 62 males and 38 females, aged 8 to 16 years were included in the study. A total of 100 patients were enrolled in the study. Traditional and cauterization tonsillectomy were performed. 50 (27 male and 23 female) patients, whose ages ranged from 9 to 16 years old underwent the traditional tonsillectomy, 50 (35 male and 15 female) patients whose ages ranged from 8 to 16 years underwent cauterization. The two groups were similar for demographic parameters. The difference between mean operative times of the two methods was statistically significant. Postoperative bleeding is significantly higher in the traditional technique compared to cauterization method. Postoperative pain is significantly less in cauterization method. Only a few patients experienced fever, bleeding, and other complications related to anesthesia. The bleeding severity is significantly lower in the cauterization technique. Postoperative pain was less in cauterization technique on day 1 and day 5. Postoperative pain was from mild to severe. Conclusion: This study revealed significantly less postoperative complications in traditional tonsillectomy in comparison with the cauterization method. Healing time was significantly faster in cauterization technique than in traditional method.
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Affiliation(s)
- Ali Maeed S Al-Shehri
- Ear, Nose and Throat Division, Surgery Department, College of Medicine, King Khalid University, Abha, KSA
| | | | | | - Abdullah Musleh
- Ear, Nose and Throat Division, Surgery Department, College of Medicine, King Khalid University, Abha, KSA
| | - Rishi Kumar Bharti
- Family & Community Medicine Department, College of Medicine, King Khalid University, Abha, KSA
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Mofatteh MR, Salehi F, Hosseini M, Hassanzadeh-Taheri M, Meghdadi S, Hassanzadeh-Taheri M. Postoperative Outcomes in Cold Dissection Versus Bipolar Electrocautery Tonsillectomy: A Randomized Double-Blind Controlled Study. Indian J Otolaryngol Head Neck Surg 2019; 71:182-187. [PMID: 31741957 DOI: 10.1007/s12070-017-1204-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/06/2017] [Indexed: 11/26/2022] Open
Abstract
Tonsillectomy is one of the oldest and most common procedures worldwide. This surgery is performed by different methods include cold dissection technique (CDT) and bipolar electrocautery technique (BET). Assessment and comparison of postoperative outcomes in cold dissection and bipolar electrocautery is the aim of present study. This randomized controlled clinical trial study was conducted as double-blind on 534 patients. The enrolled patients underwent tonsillectomy in Vali-e-Asr Hospital of Birjand city from Oct. 2013-Oct. 2015. Al patients systematically allocated into two groups treated with cold dissection or bipolar electrocautery methods. Intensity of throat pain scores, Otalgia, analgesic consumption, resume normal diet, body temperature and also wound healing on 10th day after operation were measured and compared between the two groups. The gathered data were analyzed by SPSS software (Ver-22) and using necessary tests. The differences between studied groups less than 0.5 (p < 0.05) considered significant statically. 51.7 and 50.6% in the CDT and the BET groups were male respectively. In comparison between the groups the mean of pain scores 4 and 24 h after operation in the BET group were higher significantly (p < 0.001). Otalgia only 4 h after surgery was higher significantly in the BET group (p = 0.008). All the other studied parameters were significantly more desirable in the CDT group (p < 0.001). According to the findings of present study it seems that the CDT is safer and more favorable than the BET in tonsillectomy.
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Affiliation(s)
- Mohammad Reza Mofatteh
- 1Vali-e-Asr Hospital, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Forod Salehi
- 1Vali-e-Asr Hospital, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Mehran Hosseini
- 2Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Seddigheh Meghdadi
- 2Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran
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8
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Jotić A, Savić Vujović K, Milovanović J, Vujović A, Radin Z, Milić N, Vučković S, Medić B, Prostran M. Pain Management After Surgical Tonsillectomy: Is There a Favorable Analgesic? EAR, NOSE & THROAT JOURNAL 2019; 98:356-361. [PMID: 31072190 DOI: 10.1177/0145561319846065] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to examine how ibuprofen and paracetamol prevent pain after cold-steel extracapsular tonsillectomy in children. Also, we examined the relation between age, gender, nausea, postoperative bleeding, antibiotic use, type of diet, and postoperative pain intensity and the type of administered analgesic. A prospective study was conducted on 147 children (95 males and 52 females, aged 7-17 years) who underwent tonsillectomy in the Clinical-Hospital Center "Dragiša Mišović" from January 1 to June 30, 2016. The degree of pain was measured using a visual analog scale (VAS). We did not observe any significant differences in postoperative nausea, hospitalization rate postoperative bleeding, and antibiotic use between the paracetamol and ibuprofen groups. A test of within-patient effects showed that VAS scores changed significantly during the postoperative follow-up period (P = .00), but there were no significant differences between the groups (P = .778). After 12 hours, 29.3% of the patients on paracetamol and 21.8% on ibuprofen were transferred to a soft diet; after 24 hours, 84.8% of the paracetamol group and 85.5% of the ibuprofen group were on a soft diet (χ2 test, P < .05). There was a statistically significant correlation between VAS scores measured 4 hours after the surgery and the time of transference to the soft diet (Spearman ρ test, P < .001). The transfer to soft and normal diets was not significantly different between the 2 groups as assessed by the VAS scores (Pearson χ2 test, P = .565).There is still no consensus on the most effective postoperative pain-control regiment after tonsillectomy. This study showed that satisfactory pain management was achieved equally with both paracetamol and ibuprofen.
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Affiliation(s)
- Ana Jotić
- 1 Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia.,2 Department of Otorhinolaryngology and Maxillofacial Surgery, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Katarina Savić Vujović
- 3 Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovica Milovanović
- 1 Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia.,2 Department of Otorhinolaryngology and Maxillofacial Surgery, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,4 Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,5 Clinic of Maxillofacial Surgery, Sechenov University, Moscow, Russia
| | | | - Zorana Radin
- 7 General hospital "Djorđe Jovanović", Zrenjanin, Serbia
| | - Nataša Milić
- 8 Division of Nephrology & Hypertension, Mayo Clinic, Rochester, MN, USA.,9 Department of Biostatistics, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Sonja Vučković
- 3 Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branislava Medić
- 3 Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Prostran
- 3 Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Comparison of postoperative morbidity between conventional cold dissection and bipolar electrocautery tonsillectomy: which technique is better? Braz J Otorhinolaryngol 2019; 86:427-433. [PMID: 31540869 PMCID: PMC9422487 DOI: 10.1016/j.bjorl.2018.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 12/05/2018] [Accepted: 12/21/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction Tonsillectomy is one of the most common surgeries in the head and neck worldwide. This operation is carried out by different methods, the most frequent of which are the cold dissection and bipolar electrocautery techniques. Objective This study was conducted to assess and compare postoperative morbidity between cold dissection and bipolar electrocautery. Methods This prospective randomized clinical trial was performed on 534 patients who underwent tonsillectomy in Vali-e-Asr Hospital of Birjand, east of Iran from October, 2013 to October, 2015. The patients were systematically selected for cold dissection technique or bipolar electrocautery technique groups. Time of surgery, amount of intraoperative blood loss, postoperative hemorrhage, the intensity of local pain 4 and 24 hours after operation and nausea and/or vomiting were recorded and compared in the two groups to decide which technique is better. The data were analyzed in SPSS software (ver-22). The p-value less than 0.5 was considered significant. Results In this study, 51.7% of the cold dissection technique patients and 50.6% of the bipolar electrocautery technique participants were male. Compared to the cold dissection technique, the average intraoperative blood loss was significantly lower (p < 0.001) in the bipolar electrocautery technique group, while the intensity of local pain 4 and 24 hours after the operation was significantly higher (p < 0.001). Other variables showed no significant differences between the two groups. Conclusion Based on the findings of the present investigation, the bipolar electrocautery technique is suggested for tonsillectomy in children, while the cold dissection technique is preferred for adult patients.
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Cassano M, Bayar Muluk N, Di Taranto F, Subramaniam S. A comparison of intraoperative haemostatic techniques during tonsillectomy: Suture vs electrocautery-A study to assess postoperative pain scores and duration to resumption of normal diet. Clin Otolaryngol 2018; 43:1219-1225. [PMID: 29733506 DOI: 10.1111/coa.13129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess postoperative pain and pattern of recovery to normal diet in children who underwent tonsillectomy. METHODS Cold steel tonsillectomy (or adenotonsillectomy) was performed in 61 children. Haemostasis was attained with sutures in Group 1 (n = 30, 8 tonsillectomy and 22 adenotonsillectomy), and electrocautery in Group 2 (n = 31, 6 tonsillectomy and 25 adenotonsillectomy). Information obtained included postoperative pain scores and the number of postoperative days taken to resume normal diet. The pain score was evaluated with the Wong-Baker FACES® Pain Rating Scale (WBFS). RESULTS Pain values in Group 1 (haemostasis with sutures) were significantly lower than those in Group 2 (haemostasis with cauterisation) from the 6th hour to the 7th postoperative day (P < .05). For both liquid and solid food, Group 1 returned to normal diet earlier, compared to Group 2 (P < .05). When comparing patients undergoing tonsillectomy vs adenotonsillectomy, resumption of normal diet was achieved later in the adenotonsillectomy patients (P < .05). In terms of postoperative bleeding, there were 2 significant events in Group 2 (electrocautery group), occurring on the 1st (severe) and 10th day (slight) in 2 children (6.5%). There were no postoperative bleeding events in Group 1. CONCLUSION Our results showed that suture haemostatis causes less pain and faster resumption of normal diet compared to electrocautery. In view of this, we recommend the use of sutures for achieving intraoperative haemostasis in paediatric patients.
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Affiliation(s)
- M Cassano
- Faculty of Medicine, ENT Department, University of Foggia, Foggia, Italy
| | - N Bayar Muluk
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
| | - F Di Taranto
- Faculty of Medicine, ENT Department, University of Foggia, Foggia, Italy
| | - S Subramaniam
- ENT and Skull of Base Surgery Department, Clinical fellow at Ohio State University, Columbus, OH, USA
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Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009-2016. Eur Arch Otorhinolaryngol 2017; 274:3711-3722. [PMID: 28815308 PMCID: PMC5591799 DOI: 10.1007/s00405-017-4679-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/19/2017] [Indexed: 12/19/2022]
Abstract
The objective of this study was to describe factors affecting pain after pediatric tonsil surgery, using patient reported pain-related outcome measures (pain-PROMs) from the National Tonsil Surgery Register in Sweden. In total, 32,225 tonsil surgeries on children (1 to <18 years) during 2009-2016 were included; 13,904 tonsillectomies with or without adenoidectomy (TE ± A), and 18,321 tonsillotomies with or without adenoidectomy (TT ± A). Adjustments were made for variables included in the register to compensate for contributable factors in the analysis. When compared to TE ± A for surgical indication obstruction, TT ± A resulted in lower pain-PROMs, shorter use of postoperative analgesics, earlier return to regular food intake, and lower risk for contact with health care services due to pain. Children who underwent TE ± A because of obstruction problems stopped taking painkillers and returned to normal eating habits sooner, compared to children who underwent TE ± A for infectious indications. In both indication groups, TE ± A performed with hot rather than cold technique (dissection and haemostasis) generally resulted in higher pain-PROMs. Older children reported more days on analgesics and a later return to regular food intake after TE ± A than younger ones. No clinically relevant difference between sexes was found. Between 2012 and 2016 (pre-and post-implementation of Swedish national guidelines for pain treatment), the mean duration of postoperative analgesic use had increased. In conclusion, TE ± A caused considerably higher ratings of pain-related outcome measures, compared to TT ± A. For TE ± A, cold surgical techniques (dissection and haemostasis) were superior to hot techniques in terms of pain-PROMs. Older children reported higher pain-PROMs after TE ± A than younger ones.
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Does Microscope Assistance in Cold Steel Tonsillectomy Reduce the Risk of Postoperative Hemorrhage? Results of a Prospective Cohort Study. Int J Otolaryngol 2017; 2017:8430907. [PMID: 28932244 PMCID: PMC5591894 DOI: 10.1155/2017/8430907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/16/2017] [Accepted: 07/03/2017] [Indexed: 02/06/2023] Open
Abstract
Background Posttonsillectomy hemorrhage (PTH) is the most feared complication. Dissection near the tonsillar capsule under microscopic view (TEmic) could be assumed to decrease PTH compared to traditional tonsillectomy (TEtrad). Methods In this study, patients were evaluated with respect to the need for surgical control (R/N: return/no return to theater (RTT): the day of surgery [0] or thereafter [1]). The findings at resection site and pain were measured. Results 869 patients were included (183 TEmic; 686 TEtrad). PTH requiring RTT was not seen in the TEmic group on the day of surgery (R0) while PTH requiring RTT subsequently (R1) was seen in 1.1% of the cases. In the TEmic group, hemorrhages without a need for surgical control were observed in 0.6% (N0) and 3.4% (N1), respectively. The corresponding rates for TEtrad were as follows: R0, 0.3%; R1, 1.7%; N0, 0.6%; and N1, 3.6% (p > 0.05). Postoperative edema and local infection at resection site were proven to be predictive of PTH (p = 0.007). Conclusion Microscope assistance in tonsillectomy did not statistically have an influence on the PTH even though there was a trend towards lower PTH rate in the TEmic group. Benefit for TEmic was observed in high-volume and long experienced surgeons.
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Sanlı A, Yildiz G, Erdogan BA, Paksoy M, Altin G, Ozcelik MA. Comparison of Cold Technique Tonsillectomy and Thermal Welding Tonsillectomy at Different Age Groups. Prague Med Rep 2017; 118:26-36. [PMID: 28364572 DOI: 10.14712/23362936.2017.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The aim of this study is to compare objectively advantages and disadvantages of cold technique tonsillectomy and thermal welding tonsillectomy at the same case. A total of 100 patients, 53 patients younger than 12 years of age and 47 patients elder than 12 years of age, were included in this study. Tonsillectomy was performed by using cold technique on the right side of the palatine tonsils and thermal welding on the left side. Right and left sides were compared regarding perioperative bleeding, surgical dissection time, postoperative pain scale at the 1st and 7th day and postoperative bleeding parameters. Perioperative bleeding was found to be higher in cold technique side in patients younger than 12 years of age (p<0.001). Postoperative pain score on the day 1 was significantly higher in cold technique side, whereas it was found to be higher in thermal welding side at postoperative day 7 (p<0.001). Perioperative bleeding was found to be significantly higher in cold technique side (p<0.001) and surgical dissection time of thermal welding was found to be longer (p<0.001) in patients elder than 12 years of age. Postoperative pain score at the day 1 and day 7 was found to be higher in thermal welding side (p<0.001). Postoperative pain score at the day 1 and day 7 were statistically significantly higher in patients elder than 12 years of age. As a result, both techniques have its unique superior aspects and both can be applied as a routine tonsillectomy technique.
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Affiliation(s)
- Arif Sanlı
- Department of Otolaryngology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
| | - Gazi Yildiz
- Department of Otolaryngology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
| | - Banu Atalay Erdogan
- Department of Otolaryngology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey.
| | - Mustafa Paksoy
- Department of Otolaryngology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
| | - Gokhan Altin
- Department of Otolaryngology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
| | - Muhammed Ali Ozcelik
- Department of Otolaryngology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
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Francis DO, Fonnesbeck C, Sathe N, McPheeters M, Krishnaswami S, Chinnadurai S. Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children. Otolaryngol Head Neck Surg 2017; 156:442-455. [PMID: 28094660 PMCID: PMC5639328 DOI: 10.1177/0194599816683915] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/22/2016] [Indexed: 01/21/2023]
Abstract
Objective To assess posttonsillectomy hemorrhage (PTH), associated nonoperative readmissions/revisits, and reoperations in children. Data Sources MEDLINE, EMBASE, and the Cochrane Library. Review Methods Two investigators independently screened studies against predetermined criteria and extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. We calculated unadjusted pooled estimates of PTH frequency and conducted a Bayesian meta-analysis to estimate frequency of primary and secondary PTH and PTH-associated reoperation and revisits/readmissions by partial and total tonsillectomy and surgical approach. Results In meta-analysis, the frequency of primary and secondary PTH associated with total and partial tonsillectomy was <4% for any technique and with overlapping confidence bounds. Pooled frequencies of PTH were also <5% overall (4.2% for total tonsillectomy, 1.5% for partial tonsillectomy) in comparative studies. Fewer PTH episodes occurred with tonsillectomy for obstructive sleep-disordered breathing than for throat infection. In meta-analysis, frequency of PTH-associated nonoperative revisits/readmission or reoperation ranged from 0.2% to 5.7% for total tonsillectomy and from 0.1% to 3.7% for partial tonsillectomy. At least 4 deaths were reported in case series including 1,778,342 children. Conclusions PTH occurred in roughly 4% of tonsillectomies in studies included in this review. Although studies typically did not report bleeding severity or amount, relatively few episodes of PTH necessitated reoperation for hemostasis. Nonetheless, tonsillectomy is not without risk of harm. Frequency of PTH across techniques was similar; thus, we cannot conclude that a given technique is superior.
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Affiliation(s)
- David O. Francis
- Department of Otolaryngology, Vanderbilt University Medical Center
| | - Chris Fonnesbeck
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Nila Sathe
- Department of Health Policy, Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Melissa McPheeters
- Department of Health Policy, Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Shanthi Krishnaswami
- Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center
| | - Siva Chinnadurai
- Department of Otolaryngology, Vanderbilt University Medical Center
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Walner DL, Parker NP, Miller RP. Past and Present Instrument Use in Pediatric Adenotonsillectomy. Otolaryngol Head Neck Surg 2016; 137:49-53. [PMID: 17599564 DOI: 10.1016/j.otohns.2007.02.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Accepted: 02/26/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: Examine changing trends/instrument usage for pediatric adenotonsillectomy. STUDY DESIGN AND SETTING: Survey of 300 members of the American Society of Pediatric Otolaryngology assessing instruments used in adenotonsillectomy currently and over the past 15 years. RESULTS: A total of 120 surveys were returned. The most common total tonsillectomy instruments for obstruction/infection were: monopolar electrocautery (ME) (53.1%/54.5%) and coblation (CT) (16.0%/16.1%). The most common subtotal tonsillectomy instrument for obstruction/infection was microdebrider (51.4%/30.8%). Over the past 15 years, ME predominated, cold utilization declined, and CT rose. The most common adenoidectomy instruments were ME (25.0%/25.0%), curette with touch-up ME (22.4%/22.4%), and microdebrider with touch-up ME (19.0%/14.7%). Over the past 15 years, curette with touch-up ME predominated early, curette utilization alone declined, and ME, microdebrider, and CT have risen. CONCLUSION: Pediatric otolaryngologist technique/instrument use for adenotonsillectomy has changed over the past 15 years. This study may be limited by the low survey response rate.
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Affiliation(s)
- David L Walner
- Department of Otolaryngology and Bronchoesophagology, Rush University Medical Center, Chicago, IL, USA.
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Jo SH, Mathiasen RA, Gurushanthaiah D. Prospective, Randomized, Controlled Trial of a Hemostatic Sealant in Children Undergoing Adenotonsillectomy. Otolaryngol Head Neck Surg 2016; 137:454-8. [PMID: 17765775 DOI: 10.1016/j.otohns.2006.09.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Revised: 03/19/2007] [Accepted: 04/18/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVES: To evaluate the efficacy of Floseal as a hemostatic sealant compared to traditional electrocautery hemostasis after cold knife adenotonsillectomy. STUDY DESIGN: Prospective, randomized, controlled trial of 68 consecutive patients undergoing cold steel adenotonsillectomy. Patients were randomized to receive either Floseal (FS) or electrocautery (EC) for hemostasis. RESULTS: FS patients had shorter operative times than EC patients (16 min vs 31.2 min, P < 0.0001) and less blood loss (49.2 mL vs 70.8 mL, P < 0.05). Four EC patients were crossed over to Floseal when adequate hemostasis could not be achieved in the adenoid bed. No Floseal patients were crossed over. FS patients had significantly less pain on postoperative days two through 11 ( P < 0.05) and less use of narcotic pain medications over the first 10 postoperative days ( P < 0.05). FS patients also had a faster return to regular diet (5.5 days vs 7.9 days, P < 0.01) and activity (5.3 days vs 7.8 days, P < 0.01) as compared to the EC patients. There were no significant complications in either group. CONCLUSIONS: Floseal is safe and efficacious, and decreases postoperative morbidity as compared to electrocautery hemostasis after cold steel adenotonsillectomy. SIGNIFICANCE: This study demonstrates the safety and efficacy of Floseal as a hemostatic method in children undergoing adenotonsillectomy.
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Affiliation(s)
- Stephen H Jo
- Head and Neck Surgery Department, Kaiser Permanente Medical Center, Oakland, CA 94611, USA.
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Glade RS, Pearson SE, Zalzal GH, Choi SS. Coblation Adenotonsillectomy: An Improvement Over Electrocautery Technique? Otolaryngol Head Neck Surg 2016; 134:852-5. [PMID: 16647547 DOI: 10.1016/j.otohns.2005.11.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVES: To compare postoperative complication rates of coblation and electrocautery adenotonsillectomies. STUDY DESIGN: Retrospective chart review. RESULTS: From January 2000 to June 2004, 1997 pediatric patients underwent adenotonsillectomy. 745 coblation, and 1252 electrocautery tonsillectomies were performed. Primary bleed, secondary bleed, and dehydration were seen in 3, 35, and 23 coblation, and 9, 41, and 64 electrocautery tonsillectomies, respectively. Data analysis revealed no significant difference in primary and secondary hemorrhage rate, but a higher dehydration rate in the electrocautery group ( P = 0.0423). A total of 602 coblation, 763 curette/cautery, and 632 electrocautery adenoidectomies were performed. Neck pain was seen in 0, 17, and 3 patients, respectively. Data analysis showed a higher incidence of neck pain with the curette/cautery technique compared with coblator and cautery techniques ( P = 0.0006 and P = 0.0119, respectively). CONCLUSIONS: Coblation tonsillectomy had similar rates of primary and secondary hemorrhage when compared with electrocautery tonsillectomy but a lower incidence of postoperative dehydration. Coblation adenoidectomy caused less postoperative neck pain than curette/cautery adenoidectomy without significant advantage over cautery adenoidectomy. EBM rating: B-3b
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Affiliation(s)
- Robert S Glade
- Division of Otolaryngology, George Washington University Medical Center, Washington, DC 20010, USA
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18
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Elinder K, Söderman ACH, Stalfors J, Knutsson J. Factors influencing morbidity after paediatric tonsillectomy: a study of 18,712 patients in the National Tonsil Surgery Register in Sweden. Eur Arch Otorhinolaryngol 2016; 273:2249-56. [PMID: 27020269 DOI: 10.1007/s00405-016-4001-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 03/19/2016] [Indexed: 01/05/2023]
Abstract
The objective of this study was to examine factors affecting morbidity after tonsillectomy in children. Data from the National Tonsil Surgery Register in Sweden on 18,712 patients who underwent tonsillectomy with or without simultaneous adenoidectomy between 1 and 18 years of age were analysed. This register includes data on sex, gender, surgical indication, and the surgical and haemostasis techniques used for each patient, as well as patient-reported outcomes for haemorrhage, analgesic use and antibiotic use. Comparison of patients who underwent surgery for infection versus upper airway obstruction revealed a significant increase in haemorrhage complications in the infection group. However, no significant difference remained after the adjustments for confounders in multivariable regression analysis. Instead, the increased risk among patients who underwent surgery for infection was mainly attributable to the use of bipolar diathermy and increased patient age. Patients who received surgery for infection reported more days of analgesic use, as well as more unplanned contacts with a health care service provider due to pain, compared with those who underwent surgery for upper airway obstruction. These results remained significant in multivariate analysis. The use of bipolar diathermy for haemostasis resulted in an increased risk, while the use of cold steel surgical instruments, a younger patient age and female sex led to a decreased risk. The surgical and haemostasis techniques used are the most important factors that affect morbidity after tonsillectomy in the paediatric age group. The choice of surgical techniques is of utmost importance for decreasing morbidity in these patients.
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Affiliation(s)
- Karolina Elinder
- Department of Otorhinolaryngology, Västerås Central Hospital, Västerås, Sweden
| | - Anne-Charlotte Hessén Söderman
- Division of Clinical Science, Intervention and Technology, Department of Otorhinolaryngology Aleris Sabbatsberg, Karolinska Institutet, Stockholm, Sweden
| | - Joacim Stalfors
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, and Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Johan Knutsson
- Department of Otorhinolaryngology, Västerås Central Hospital, Västerås, Sweden
- Centre for Clinical Research, Uppsala University, County Hospital, Västerås, Sweden
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Faiz SHR, Rahimzadeh P, Alebouyeh MR, Sedaghat M. A Randomized Controlled Trial on Analgesic Effects of Intravenous Acetaminophen versus Dexamethasone after Pediatric Tonsillectomy. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:e9267. [PMID: 24719693 PMCID: PMC3971785 DOI: 10.5812/ircmj.9267] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 05/02/2013] [Accepted: 05/19/2013] [Indexed: 11/22/2022]
Abstract
Background A few studies are available actually comparing the clinical efficacy of intravenous acetaminophen with other medications such as dexamethasone to inhibit postoperative adverse events in children. Objectives This randomized blinded controlled trial was designed to compare controlling status of postoperative events in children after tonsillectomy randomized to receive either intravenous acetaminophen or dexamethasone. Patients and Methods Eighty four children aged between 4 to 13 undergoing tonsillectomy were randomized using a computer-generated schedule to double-blind treatment with intravenous acetaminophen (15 mg/kg) or intravenous dexamethasone (0.1 mg/kg). Children were post-operatively assessed for swallowing pain, pain while opening mouth, ear pain, and postoperative sore throat in recovery room (within one hour after surgery), at the time of admission to the ward, as well as at 12 and 24 hours after surgery, assessed by the objective pain scoring system (OPS; minimum score: 0 = no pain, maximum score: 10 = extreme pain). Results There were no significant differences between the two groups with regard to the severity of postoperative pain due to swallowing or opening mouth measured at the different study time points from postoperative recovery to 24 hours after the surgery. There was no difference in ear pain severity at the time of postoperative recovery, at the admission time to ward and also at 12 hours after surgery; however mean score of ear pain severity was significantly higher in those who administered acetaminophen 24 hours after operation. Also, the mean score severity of sore throat was significantly higher in the acetaminophen compared with the dexamethasone group within 12 hours of surgery. Postoperative vomiting and bleeding were similarly observed between the two study groups. The severity of swallowing pain, pain while opening mouth, ear pain, as well as postoperative sore throat as gradually assuaged within 24 hours of tonsillectomy in both groups, however no between-group differences were observed in the trend of the severity of these events. Conclusions The dexamethasone-based regimen may have more advantage over the intravenous acetaminophen regimen for inhibiting pain and PONV following tonsillectomy in children.
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Affiliation(s)
- Seyed Hamid Reza Faiz
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
| | - Poupak Rahimzadeh
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
- Corresponding Author: Poupak Rahimzadeh, Rasoul-Akram Medical Center, Tehran University of Medical Sciences, Tehran, IR Iran. Tel/fax: +98-2166509059, E-mail: ;
| | - Mahmoud Reza Alebouyeh
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
| | - Minow Sedaghat
- Department of Anesthesiology and Pain Medicine, Rasoul-Akram Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
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Adherence of Randomized Trials Within Children's Surgical Specialties Published During 2000 to 2009 to Standard Reporting Guidelines. J Am Coll Surg 2013; 217:394-399.e7. [DOI: 10.1016/j.jamcollsurg.2013.03.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/02/2013] [Accepted: 03/05/2013] [Indexed: 02/07/2023]
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Comparison of ropivacaine, bupivacaine and lidocaine in the management of post-tonsillectomy pain. Int J Pediatr Otorhinolaryngol 2012; 76:1831-4. [PMID: 23021528 DOI: 10.1016/j.ijporl.2012.09.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/23/2012] [Accepted: 09/03/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To compare the efficacy of preoperative peritonsillar injection of ropivacaine, bupivacaine and lidocaine for pediatric tonsillectomy. PATIENTS AND METHODS Between March 2009 and April 2012, 120 patients (66 males and 54 females) between ages of 4 and 13 years were included to the study. After informed consent was obtained from the parents, the patients were randomized into four groups. In Group 1 (31 patients, mean age 8.40 ± 4.05 years) received topical lidocaine hydrochloride with 1:100,000 epinephrine was applied to surgical bed following tonsillectomy. Group 2 (29 patients, mean age 8.15 ± 4.20 years) and group 3 (31 patients, mean age 7.75 ± 3.95 years) were administered 0.25% bupivacaine hydrochloride with 1:200,000 epinephrine and 0.5% ropivacaine respectively. In Group 4 (29 patients, mean age 8.15 ± 4.20 years) topical 0.9% saline was used. The operation time, postoperative pain, amount of intraoperative blood loss, postoperative hemorrhage and complications were assessed. The intensity of pain was scored on a visual analogue scale. The patients were followed up for 3 weeks after surgery. RESULTS The difference between mean operative time of the three groups against saline injected group was statistically significant (p<0.001). The difference between mean intraoperative blood loss of the lidocaine group against three groups was statistically significant (p<0.001). None of the patients in four groups experienced primary and secondary hemorrhage. The difference between mean pain score between ropovacaine and bupivacaine groups was not statistically significant (p>0.001). The difference between mean pain score of the two groups against lidocaine and saline groups was statistically significant (p<0.001). CONCLUSION Ropivacaine infiltration is as effective as bupivacaine for post-tonsillectomy pain management in children. In view of potential side effects of bupivacaine-epinephrin combination, ropivacaine is a safer choice, for post-tonsillectomy pain relief.
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Tepe Karaca Ç, Çelebi Ş, Oysu Ç, Çelik Ö. Does cooling the tonsillar fossae during thermal welding tonsillectomy have an effect on postoperative pain and healing? Eur Arch Otorhinolaryngol 2012; 270:363-6. [DOI: 10.1007/s00405-012-2129-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 07/18/2012] [Indexed: 10/28/2022]
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García-Matte R, María Constanza Beltrán M, Ximena Fonseca A, Pamela Zúñiga C. Management of children with inherited mild bleeding disorders undergoing adenotonsillar procedures. Int J Pediatr Otorhinolaryngol 2012; 76:291-4. [PMID: 22188821 DOI: 10.1016/j.ijporl.2011.11.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 11/23/2011] [Accepted: 11/25/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the incidence of perioperative bleeding among children with mild bleeding disorders who underwent adenotonsillar surgery in our hospital and were treated with our perioperative bleeding prophylaxis protocol. METHODS Retrospective chart review was aimed at determining the perioperative bleeding rate in children with mild bleeding disorders subjected to our prophylactic protocol while undergoing adenotonsillar procedures. Low von Willebrand factor (LVWF), unspecific platelet function disorders (UPFD) and mild factor VII deficiency were considered as mild bleeding disorders. The protocol utilizes intravenous desmopressin, tranexamic acid, NSAID avoidance, and overnight observation. RESULTS Between 2004 and 2009, 44 children with mild bleeding disorders underwent adenotonsillar procedures in our hospital and were treated with the protocol. One patient (LVWF+UPFD) developed perioperative bleeding (2.3%). CONCLUSIONS It is possible to obtain low rates of perioperative bleeding in children with mild bleeding disorders undergoing adenotonsillar procedures, provided there is a well-timed diagnosis and an adequate prophylaxis protocol. We believe that further efforts must be directed at preoperative diagnosis of mild bleeding disorders to ensure safer surgeries.
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Affiliation(s)
- Raimundo García-Matte
- Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Yilmaz M, Duzlu M, Catli T, Ustun S, Ceylan A. Thermal welding versus cold knife tonsillectomy: a prospective randomized study. Kaohsiung J Med Sci 2011; 28:270-2. [PMID: 22531306 DOI: 10.1016/j.kjms.2011.06.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 01/26/2011] [Indexed: 11/24/2022] Open
Abstract
This is a prospective randomized study conducted in a group of children who underwent two methods of tonsillectomy: thermal welding or cold knife tonsillectomy. Parameters, such as postoperative pain scores, intraoperative blood loss, operation time, and postoperative bleeding rates, were analyzed to find out which technique is better. Ninety-one children (aged between 2 years and 13 years) with recurrent tonsillitis, obstructive sleep apnea syndrome, or both were included in the study. According to the type of tonsillectomy procedure, the patients were divided into two groups: cold knife and thermal welding procedure. The two groups were compared on the basis of postoperative pain scores, intraoperative blood loss, operation time, and postoperative bleeding. Fifty-seven patients underwent thermal welding tonsillectomy and 34 had cold knife tonsillectomy. The mean pain score in thermal welding group was significantly lower (p<0.001). There was no remarkable blood loss intraoperatively in the thermal welding procedure. The operation time was not significantly different between two groups. No postoperative bleeding was encountered in the thermal welding group. Compared with the cold knife technique, thermal welding was found to be a relatively new and safe technique for tonsillectomy as it results in significantly less postoperative pain and no remarkable blood loss.
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Affiliation(s)
- Metin Yilmaz
- Department of Otolaryngology, Faculty of Medicine, Gazi University, Ankara, Turkey.
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25
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Jones DT, Kenna MA, Guidi J, Huang L, Johnston PR, Licameli GR. Comparison of Postoperative Pain in Pediatric Patients Undergoing Coblation Tonsillectomy versus Cautery Tonsillectomy. Otolaryngol Head Neck Surg 2011; 144:972-7. [DOI: 10.1177/0194599811400369] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective. To compare postoperative pain scores between monopolar electrocautery and coblation subcapsular tonsillectomy. Study Design. Prospective double-blind randomized study. Setting. Tertiary care children’s hospital. Subjects and Methods. Between December 2004 and April 2008, 61 children, ages 4 to 20 years (mean age, 10 years; SD, 4 years), were randomized to have one tonsil removed by electrocautery and the other tonsil removed by coblation. Subjects used the FACES scale to rate pain on each side immediately postoperatively, 2 days postoperatively, and 2 weeks postoperatively. Postoperative hemorrhage was also tracked. Results. Coblation tonsillectomy resulted in statistically less pain than electrocautery immediately after surgery, but this difference was not clinically significant. Conclusions. Pediatric pain is similar following monopolar electrocautery or coblation subcapsular tonsillectomy.
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Affiliation(s)
- Dwight T. Jones
- Department of Otolaryngology and Communication Enhancement, Children’s Hospital Boston, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret A. Kenna
- Department of Otolaryngology and Communication Enhancement, Children’s Hospital Boston, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica Guidi
- Department of Otolaryngology and Communication Enhancement, Children’s Hospital Boston, Boston, Massachusetts, USA
| | - Lin Huang
- Clinical Research Program, Children’s Hospital Boston, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick R. Johnston
- Clinical Research Program, Children’s Hospital Boston, Boston, Massachusetts, USA
| | - Greg R. Licameli
- Department of Otolaryngology and Communication Enhancement, Children’s Hospital Boston, Boston, Massachusetts, USA
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
BACKGROUND This is an update of a Cochrane Review first published in The Cochrane Library in Issue 4, 2001 and previously updated in 2003.Tonsillectomy is a commonly performed surgical procedure. There are several operative methods currently in use, but the superiority of one over another has not been clearly demonstrated. OBJECTIVES To compare the morbidity associated with tonsillectomy by two different techniques - dissection and diathermy. SEARCH STRATEGY We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3), PubMed, EMBASE, CINAHL, Web of Science, BIOSIS Previews, ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 1 October 2010, following a previous update search in 2003. SELECTION CRITERIA Randomised controlled trials of children and adults undergoing tonsillectomy or adenotonsillectomy by dissection or diathermy techniques. DATA COLLECTION AND ANALYSIS Two review authors selected studies, extracted data and assessed risk of bias independently. MAIN RESULTS Two studies (254 participants) are included in the review. The overall risk of bias in the included studies was low, although we excluded pain data from one study due to unclear risk of bias. One study compared monopolar dissection diathermy with conventional cold dissection in children and the other compared microscopic bipolar dissection with cold dissection in children and adults. These studies demonstrate reduced intraoperative bleeding, but increased pain in the diathermy group. There was no difference in the rate of secondary bleeding overall, although the power of both studies to detect a small difference was insufficient. AUTHORS' CONCLUSIONS There are insufficient data to show that one method of tonsillectomy is superior. There is evidence that pain may be greater after monopolar dissection. Large, well designed randomised controlled trials are necessary to determine the optimum method for tonsillectomy.
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Hirunwiwatkul P, Kanjanaumporn J. Vessel sealing system uvulopalatoplasty versus uvulopalatal flap: a randomized, controlled study of efficacy and adverse effects. Eur Arch Otorhinolaryngol 2011; 268:1383-90. [PMID: 21400127 DOI: 10.1007/s00405-011-1553-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 02/14/2011] [Indexed: 11/25/2022]
Abstract
The objective of this randomized, controlled study is to compare intraoperative blood loss, operative time, postoperative pain and postoperative adverse effects (bleeding, velopharyngeal insufficiency and others) between vessel sealing system uvulopalatoplasty (VSSU) and uvulopalatal flap (UPF). The study was conducted at the Department of Otolaryngology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 31 subjects with sleep-disordered breathing and obstruction at the retropalatal level were enrolled consecutively. Intervention was randomized by mixed block randomization into 2 groups (UPF, VSSU). Stratification was also done by the presence or absence of concomitant tonsillectomy. Measured outcomes, which were blinded to patients and outcome assessor, were intraoperative blood loss, operative time, postoperative pain, postoperative bleeding, postoperative velopharyngeal insufficiency and other adverse effects. Median (IQR) of intraoperative blood loss from VSSU and UPF was 0.00 (0.00-1.00) and 6.00 (1.25-12.75) ml (p < 0.001). Median (IQR) of operative time from VSSU and UPF was 3.50 (3.00-5.00) and 15.00 (12.25-18.00) min (p < 0.001). There was significantly less pain in VSSU group on operative day (p = 0.001) and postoperative day 1 (p = 0.009). However, no significant difference of pain on postoperative day 2 to day 14 (p = 0.055-0.983) between both groups. Regarding postoperative bleeding, 1 case of immediate bleeding in UPF group and 1 case of delayed bleeding in VSSU group were found in this study. Postoperative velopharyngeal insufficiency and other adverse effects were not found in both groups. In conclusion, VSSU was better than UPF in terms of less intraoperative blood loss, less operative time and less pain in early postoperative period. Postoperative velopharyngeal insufficiency and other adverse effects were not found in both groups.
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Ferreira RF, Serapiao CJ, Ferreira APRB, Rajgor D, Shah J, Possamai DS, Pietrobon R. Cost and outcomes after cold and mixed adenotonsillectomy in children1. Laryngoscope 2010; 120:2301-5. [DOI: 10.1002/lary.21137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Tanyeri HM, Polat S. Temperature-controlled radiofrequency tonsil ablation for the treatment of halitosis. Eur Arch Otorhinolaryngol 2010; 268:267-72. [DOI: 10.1007/s00405-010-1356-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 07/25/2010] [Indexed: 10/19/2022]
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Making sense out of the tonsillectomy literature. Int J Pediatr Otorhinolaryngol 2009; 73:1499-506. [PMID: 19346010 DOI: 10.1016/j.ijporl.2009.02.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 02/10/2009] [Accepted: 02/12/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND With the increase in new technology and changing indications for tonsillectomy, the literature has exploded during the last 20 years with scores of publications reporting the relative effectiveness of many different techniques. Despite this "wealth of information," no single technique has been adopted by most surgeons. OBJECTIVES To systematically analyze the usefulness of this literature of the past 20 years concerning tonsillectomy technique in children. To propose the use of specific study parameters that could optimize clinical decision-making and future research. METHODS Detailed review of the methodologies and findings in articles which compared one or more tonsillectomy techniques in clinical trials of children, ages 1-23 years from 1987 through 2007. RESULTS The Medline search revealed 255 papers of which 89 studies were suitable for inclusion in our review. In these 89 studies (found in 87 papers), 9 dissection techniques, 3 planes of dissection, 8 methods of hemostasis, and 41 different outcome measures were reported. Forty-four (49%) were described as randomized, 63 (71%) prospective, 25 retrospective (28%), 1 case report, 1 matched pair, and 9 case series papers. Sixteen (18%) trials were non-blind, 23 (26%) were single blind, 17 (19%) were double blind, and 7 (8%) were not stated. Seventy-five (84%) were comparative and 14 (16%) non-comparative. Eight (9%) studies reported power analyses. Twelve (13%) had no follow-up; 67 (75%) of the studies performed had short-term follow-up in the peri-operative period; 10 (11%) had follow-up for greater than 1 year. Eleven (12%) mentioned outcomes related to the effectiveness of the procedure itself in relieving symptoms for which the surgery was done. CONCLUSIONS Tonsillectomy technique research is of obvious interest to the otolaryngologist. We found deficits in: the precise reporting of surgical techniques, adequate study design and useful outcome measures, all of which make the literature less useful than it could be. Guidelines for study design parameters which could lead to more valuable information for the clinician are suggested.
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Comparing the effectiveness of "plasma knife" tonsillectomy with two well-established tonsillectomy techniques: cold dissection and bipolar electrocautery. A prospective randomized study. Int J Pediatr Otorhinolaryngol 2009; 73:1195-8. [PMID: 19500859 DOI: 10.1016/j.ijporl.2009.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Revised: 05/02/2009] [Accepted: 05/05/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a new device "plasma knife" for tonsillectomy by comparing to two well-established tonsillectomy techniques: cold dissection, and bipolar electrocautery. METHODS A prospective, randomized study conducted on 110 patients undergoing tonsillectomy. Subjects were randomized to plasma knife (PKT), cold dissection (CDT) and bipolar electrocautery (BET) groups. Operative time, intraoperative blood loss and postoperative complications were recorded. Pain/discomfort level of patients and healing time of the tonsillar fossae were assessed postoperatively. Data were recorded and statistically analyzed. RESULTS Operative time with plasma knife and bipolar electrocautery were associated with a significant decrease in operative time compared to cold dissection (p<0.05). Intraoperative blood loss was significantly decreased with plasma knife, compared to cold dissection and bipolar electrocautery (p<0.05). Less postoperative pain was observed with plasma knife compared to bipolar electrocautery but more postoperative pain was observed with both compared to CDT (p<0.05). Postoperative healing time was longer with plasma knife and bipolar electrocautery, compared to cold dissection (p<0.05). CONCLUSION Plasma knife is a useful and safe device in tonsillectomy. Its use reduces intraoperative blood loss and provides a fast tonsillectomy with acceptable morbidity.
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Bipolar diathermy versus cold dissection in paediatric tonsillectomy. Int J Pediatr Otorhinolaryngol 2009; 73:793-5. [PMID: 19041143 DOI: 10.1016/j.ijporl.2008.09.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2008] [Revised: 09/20/2008] [Accepted: 09/28/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To compare bipolar diathermy with cold dissection in paediatric tonsillectomy. METHODS One hundred and fifty children were randomized equally into bipolar diathermy tonsillectomy (BDT) and cold dissection tonsillectomy (CDT). Operative time, operative blood loss, postoperative pain, diet intake, activity level and complications were compared in the 2 groups. RESULTS The 2 groups were comparable in age and sex distribution. Operative time and blood loss was significantly less in the diathermy group. No significant difference in the postoperative pain except on the 3rd day in which the cold dissection group showed significantly lower pain score. Mean percentage of diet was significantly higher in the diathermy group on the 1st day. No significant difference between the 2 groups in terms of postoperative activity and complications. CONCLUSION BDT is a safe technique of tonsillectomy. There is significant less operative time and blood loss with similar morbidity compared to CDT, so it can be used safely in children.
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Stephens J, Singh A, Hughes J, Goswami T, Ghufoor K, Sandhu G. A prospective multi-centre randomised controlled trial comparing PlasmaKnife with bipolar dissection tonsillectomy: evaluating an emerging technology. Int J Pediatr Otorhinolaryngol 2009; 73:597-601. [PMID: 19157574 DOI: 10.1016/j.ijporl.2008.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 12/11/2008] [Accepted: 12/12/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To clinically evaluate and compare the PlasmaKnife to bipolar electrocautery in paediatric tonsillectomy. METHODS A prospective, multi-centred, double-blinded randomised controlled trial, conducted in central London teaching hospitals. The participants were 100 patients aged 2-16 years with recurrent tonsillitis or obstructive adenotonsillar hypertrophy awaiting a tonsillectomy were recruited in to the study. The primary outcome measures were throat, ear and swallowing pain scores over two weeks. Secondary outcome measures were return to normal diet, return to normal activity, analgesic requirements, operation time and intra-operative blood loss. RESULTS Surgical dissection was similar between the two groups with minimal blood loss and comparable overall operative times. We found that PlasmaKnife tonsillectomy caused more throat pain at 24 h (p=0.02). There was a tendency for a higher proportion in the bipolar dissection group to return to a normal diet, at day 3 (p=0.05) and at day 7 (p=0.04). The bipolar dissection returned to normal activities in a larger proportion than the PlasmaKnife group at day 3 (p=0.02) and at day 7 (p=0.01). There is some evidence of an association between use of analgesia at day 14 and method of tonsillectomy (p=0.03); the PlasmaKnife group tended to use less analgesia. During the study, four secondary bleeds occurred in the PlasmaKnife group and one in the bipolar dissection group, and all were managed conservatively. CONCLUSION Our study has found no significant advantage to PlasmaKnife over bipolar diathermy tonsillectomy. However, this preliminary study finds PlasmaKnife to be an interesting instrument and may warrant a larger randomised study to evaluate the potential advantages.
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Affiliation(s)
- J Stephens
- Charing Cross Hospital, Hammersmith NHS Trust, Fulham Palace Road, London W6 8RF, United Kingdom.
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Stuck BA, Götte K, Windfuhr JP, Genzwürker H, Schroten H, Tenenbaum T. Tonsillectomy in children. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:852-60; quiz 860-1. [PMID: 19561812 PMCID: PMC2689639 DOI: 10.3238/arztebl.2008.0852] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 08/28/2008] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Tonsillectomy is one of the most frequently performed surgical interventions in children. In the following, indications, preoperative evaluation, surgical techniques and postoperative complications will be discussed. METHODS Literature search in PubMed (National Library of Medicine) focusing on publications in German or English up to June 2008. RESULTS Indications are selected infectious diseases, upper airway obstruction for example due to tonsillar hypertrophy, and a suspected malignancy. Viral infections of the tonsils without upper airway obstruction are not an indication for surgery; in the case of acute bacterial tonsillitis, tonsillectomy is no longer recommended. In recurrent tonsillitis, tonsillectomy is only effective in specific and narrow indications. The indication for tonsillectomy in sleep-disordered breathing due to adenotonsillar hypertrophy has to be based on clinical assessment, medical history, and a sleep history. The most relevant risk factors are obstructive sleep apnea and coagulation disorders. A standardized history regarding hemostasis and bleeding is mandatory, and is superior to routine coagulation tests. Postoperative bleeding is still the most relevant complication of tonsillectomy and is always an emergency situation. CONCLUSION Tonsillectomy is one of the most frequently performed interventions in children but should be considered with care, as life-threatening complications can occur.
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Affiliation(s)
- Boris A Stuck
- Universitäts-HNO-Klinik Mannheim,Theodor-Kutzer-Ufer 1-3, Mannheim, Germany.
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Chimona T, Proimos E, Mamoulakis C, Tzanakakis M, Skoulakis CE, Papadakis CE. Multiparametric comparison of cold knife tonsillectomy, radiofrequency excision and thermal welding tonsillectomy in children. Int J Pediatr Otorhinolaryngol 2008; 72:1431-6. [PMID: 18620759 DOI: 10.1016/j.ijporl.2008.06.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 05/29/2008] [Accepted: 06/05/2008] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This is a prospective study evaluating certain intraoperative and postoperative parameters, comparing the relatively new technique of thermal welding tonsillectomy with cold knife tonsillectomy, and radiofrequency excision in pediatric population. METHODS Ninety children aged from 5 through 13 years were enrolled a randomized prospective trial comparing cold knife tonsillectomy, radiofrequency excision, and thermal welding tonsillectomy. Indications included recurrent acute tonsillitis and/or obstructive sleep apnea syndrome. All techniques were compared by means of length of surgery time, blood loss, postoperative bleeding and postoperative pain. RESULTS Sixty-eight patients underwent tonsillectomy for obstructive sleep apnea, whereas 22 children underwent tonsillectomy due to recurrent acute tonsillitis. Median values of all variables tested, length of surgery time, blood loss, postoperative bleeding and postoperative pain, were found to differ significantly among the three surgical techniques (P<0.001). Particularly, a statistically significant higher median duration (P<0.001) and intraoperative blood loss (P<0.001), as well as, a statistically significant lower median pain score in each day tested (P<0.001) of the cold knife group, compared to each one of the other two groups, were found. Tissue welding and radiofrequency groups did not differ significantly in any aspect tested. CONCLUSIONS Both thermal welding and radiofrequency excision techniques have shown comparable results regarding intraoperative blood loss, postoperative hemorrhage, and pain. Compared with cold knife tonsillectomy, welding and radiofrequency excision techniques were associated with less intraoperative blood loss and duration, though cold knife tonsillectomy seems to prevail over the two techniques in terms of the postoperative pain.
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Affiliation(s)
- T Chimona
- ENT Department, Chania General Hospital, Crete, Greece.
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Electrosurgery as a risk factor for secondary post-tonsillectomy hemorrhage. Eur Arch Otorhinolaryngol 2008; 266:111-6. [DOI: 10.1007/s00405-008-0720-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Accepted: 05/21/2008] [Indexed: 02/06/2023]
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Singh A, Stephens J, Ghufoor K, Sandhu G. A prospective study comparing PlasmaKnife with bipolar dissection tonsillectomy: a preliminary communication of an emerging technology. Clin Otolaryngol 2008; 33:277-80. [DOI: 10.1111/j.1749-4486.2007.01591.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Michel RG, Weinstock BI, Tsau K. Safety and Efficacy of Pressure-assisted Tissue-welding Tonsillectomy: A Preliminary Evaluation. EAR, NOSE & THROAT JOURNAL 2008. [DOI: 10.1177/014556130808700213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We conducted a retrospective study of the safety and efficacy of a new pressure-assisted tissue-welding technology (ENTceps; Starion Instruments Corp.; Sunnyvale, Calif.) for total tonsillectomy, either alone or with adenoidectomy. The use of this instrument was compared in two groups of patients categorized by age. The younger group was made up of 50 patients aged 2 to 12 years who had undergone total tonsillectomy and adenoidectomy (T&A), and the older group was made up of 50 patients aged 13 to 47 years who had undergone either T&A or isolated total tonsillectomy. The primary safety endpoint was the presence or absence of intra- or postoperative complications—particularly the amount of intraoperative blood loss and the incidence of delayed postoperative bleeding. In each group, the mean amount of intraoperative blood loss was no more than 30 ml, and only 2 of the 100 patients experienced postoperative hemorrhage. Among the efficacy parameters were the amount of operating and recovery time and the postoperative appearance of the tonsillar fossae. The mean operating time was 13.0 minutes in the younger group and 19.5 minutes in the older group, and the mean total recovery times were 120.0 and 130.4 minutes, respectively; all tonsillar fossae were well epithelialized by 2 weeks after surgery. Finally, surgical morbidity was determined on the basis of the amount of perioperative pain medication administered, the number of unscheduled patient telephone contacts and clinic visits, and the amount of time needed to return to a normal diet and activities. Nine patients in the younger group and 6 in the older group required no pain medications during recovery; overall, pain was not a significant issue for most patients. Sixteen patients made a total of 20 telephone calls and 8 clinic visits prior to their scheduled postoperative appointment; almost all of these encounters dealt with postoperative pain. Only 1 patient, who had previously undiagnosed von Willebrand disease, had not returned to a normal diet and activities by the end of 1 week. Based on our preliminary findings—and a comparison of our results with those of other studies published in the literature relative to the amount of intraoperative bleeding, the incidence of postoperative bleeding, and operating times—we conclude that pressure-assisted tissue-welding technology is safe and compares favorably with other tonsillectomy techniques. This method of electrocautery is straightforward and relatively easy to learn.
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Affiliation(s)
- Randall G. Michel
- From the Department of Surgery (Otolaryngology), Lompoc (Calif.) District Hospital
| | - Bernard I. Weinstock
- From the Department of Surgery (Otolaryngology), Lompoc (Calif.) District Hospital
| | - Kang Tsau
- Department of Anesthesiology, Lompoc (Calif.) District Hospital
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Cardozo AAJ, Hallikeri C, Lawrence H, Sankar V, Hargreaves S. Teenage and adult tonsillectomy: dose-response relationship between diathermy energy used and morbidity. Clin Otolaryngol 2008; 32:366-71. [PMID: 17883557 DOI: 10.1111/j.1749-4486.2007.01529.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether an increase in the use of bipolar diathermy energy to perform a tonsillectomy is associated with an increase in postoperative pain and haemorrhage. STUDY DESIGN Prospective study. SETTING District General Hospital. METHODS In all, 101 patients above the age of 13 years who underwent a tonsillectomy that involved the use of bipolar diathermy during the study period were included. The cumulative amount of diathermy energy used to perform each tonsillectomy was calculated with the help of a digital stop clock timing device connected to the diathermy foot-pedal. MAIN OUTCOME MEASURES Postoperative pain scores and the incidence of secondary haemorrhage were recorded for each patient at four points in time following surgery, up to the tenth postoperative day. The haemorrhage rates were categorised into three groups (no bleeding, minor bleeding and major bleeding) according to severity. Associations between the diathermy energy used to perform each tonsillectomy and the corresponding postoperative pain scores and secondary bleeding rates were investigated. RESULTS There was a statistically significant positive relationship between the total amount of bipolar diathermy energy used per tonsillectomy and the pain scores at all the four recorded points in time (r(s) = 0.44-0.72, P < 0.001). When the median energy consumption in the three groups (no bleeding, minor bleeding and major bleeding) were compared using the Kruskal-Wallis test, we found that there was limited evidence of a difference between the groups, but this was not statistically significant at the 5% level [H (2) = 5.374, P = 0.065, 99% CI 0.058-0.071]. CONCLUSIONS Increased use of bipolar diathermy during the performance of a tonsillectomy is associated with a statistically significant increased amount of postoperative pain. The dose-response relationship between diathermy energy and postoperative bleeding is less clear. This suggests that there could be other important factors such as surgical instrument characteristics and degree of tonsillar adherence that have an additional influence and are therefore possible areas for future research.
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Affiliation(s)
- A A J Cardozo
- Department of Otolaryngology, Royal Bolton Hospital, Bolton, Lancashire, UK.
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Abstract
Sleep-related breathing disorders (SRBD) in children are caused by a diverse group of anatomic and physiologic pathologies. These disorders share a common clinical presentation as stertor or sonorous breathing, occasionally accompanied by apneic events of variable duration. Successful management depends on accurate identification of the site of obstruction and the severity of obstruction. Intervention, both surgical and nonsurgical, is tailored to the disorder. In children with SRBD, such intervention may alter behavior and cognition, improve sleep and feeding, or even save a life.
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Affiliation(s)
- David H Darrow
- Department of Otolaryngology, Eastern Virginia Medical School, 825 Fairfax Avenue, Norfolk, VA 23507, USA.
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Krajewski M, Samoliaski B, Schmidt J. [Endoscopic adenotomy--clinical assessment of value and safety--an own experience]. Otolaryngol Pol 2007; 61:21-4. [PMID: 17605413 DOI: 10.1016/s0030-6657(07)70377-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
High number of performed adenotomies inclines ENT surgeons to introduce more and more satisfying concerning safety, accuracy and results predictability surgical techniques. The aim of our study was to assess the value and safety of an endoscopic surgical technique. The study was performed on 768 patients aged 7 months - 14 years. Group A (I) consisted of 453 patients on whom adenotomy was performed with use of Beckmann adenotome. Group B (II) consisted of 315 patients operated under endoscope control with the use of Jurasz forceps. An endoscopic technique gives remarkable decrease of intraoperative blood loss and eliminates post op bleedings, what increases patients safety. Low aggressiveness of an endoscopic technique compared to classic decreases incidents of undesirable post adenotomy signs and symptoms. In authors opinion, the results obtained during study, definitely prove the superiority of endoscopic technique--it is worth of introducing into daily surgical practice.
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Lee KD, Lee HS, Hong JC, Yu TH, Lee HH, Chun BG, Gil YG, Kim KH. Diameter of vessels across the tonsillar capsule as an anatomical consideration for tonsillectomy. Clin Anat 2007; 21:33-7. [DOI: 10.1002/ca.20562] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ashbach MN, Ostrower ST, Parikh SR. Tonsillectomy Techniques and Pain: A Review of Randomized Controlled Trials and Call for Standardization. ACTA ACUST UNITED AC 2007; 69:364-70. [DOI: 10.1159/000108369] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Heyden HV, Schäfer E, Jecker P, Gosepath J, Mann WJ. Tonsillektomie mit Koagulationsschere oder Raspatorium. HNO 2006; 55:684-9. [PMID: 17136555 DOI: 10.1007/s00106-006-1502-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Postoperative bleeding is the major complication in tonsillectomy, and pain the most common side effect. The use of bipolar scissors versus blunt dissection tonsillectomy were compared in this study in order to evaluate postoperative bleeding and pain, as well as operative time. METHODS In this case control study, 138 patients with the diagnosis of chronic tonsillitis, mononucleosis or a peritonsillar abscess were divided into two groups. A total of 78 patients were operated using bipolar scissors while 60 patients underwent tonsillectomy by blunt dissection. Operating time, frequency of postoperative bleeding and the postoperative pain score were compared between these two groups. RESULTS The average operating time in the bipolar scissor group showed a tendency to be shorter than in the blunt dissection group (mean 4.1 min), although this did not reach a level of statistical significance. No differences were seen in pain scores or in the incidence of postoperative bleeding. CONCLUSION The data documented in this study show that tonsillectomy with bipolar scissors might represent a surgical option to reduce surgical time in a larger patient group. Postoperative pain and the incidence of postoperative bleeding did not show any statistical difference between the two surgical techniques.
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Affiliation(s)
- H v Heyden
- Abteilung für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Mainz, Mainz, Germany.
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Akoglu E, Akkurt BCO, Inanoglu K, Okuyucu S, Dagli S. Ropivacaine compared to bupivacaine for post-tonsillectomy pain relief in children: a randomized controlled study. Int J Pediatr Otorhinolaryngol 2006; 70:1169-73. [PMID: 16414124 DOI: 10.1016/j.ijporl.2005.12.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Revised: 12/02/2005] [Accepted: 12/06/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the effects of ropivacaine and bupivacaine on post-tonsillectomy pain in children. METHODS Forty-six children aged 2-12 years, undergoing tonsillectomy were enrolled in the study. Group 1 (n=16) received bupivacaine, group 2 (n=15) received ropivacaine, and a group 3 (control) (n=15) received 9% NaCl (saline) infiltrated around each tonsil. Pain was evaluated using a modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) recorded 15 min and 1, 4, 12, 16, and 24h postoperatively. RESULTS No difference was found in the demographic data among the groups. The pain scores were similar between the bupivacaine and ropivacaine groups (p>0.05). The pain scores in both analgesia groups were significantly (p<0.05) lower 1, 4, 12, 16, and 24h postoperatively compared to the control group. Analgesic requirements and the time to first analgesia were also significantly (p<0.05) different between the analgesia and control groups. CONCLUSION Local ropivacaine infiltration is a safe and effective method and equivalent to bupivacaine for post-tonsillectomy pain.
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Affiliation(s)
- Ertap Akoglu
- Department of Otolaryngology, Mustafa Kemal University Medical Faculty, Araştirma Hastanesi, 31100 Antakya, Turkey
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Cunnington J. Facilitating benefit, minimising risk: Responsibilities of the surgical practitioner during electrosurgery. J Perioper Pract 2006; 16:195, 197-202. [PMID: 16669365 DOI: 10.1177/175045890601600404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This article will explore the role of the surgical practitioner in providing best care for the patient, by discussing electrosurgical intervention (ESI). It will exemplify the technological aspect of the role. Management of ESI equipment, and its inherent risks, will be shown to relate directly to the practitioner's role. Some safety claims for ESI equipment will be analysed, demonstrating the need for a theatre practitioner to establish the validity of sources that inform practice. The roles of circulating practitioner and scrubbed practitioner will be elucidated, with exploration of professional and ethical responsibilities to the patient, themselves and colleagues.
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Ragab SM. Bipolar radiofrequency dissection tonsillectomy: a prospective randomized trial. Otolaryngol Head Neck Surg 2006; 133:961-5. [PMID: 16360521 DOI: 10.1016/j.otohns.2005.07.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To conduct a prospective randomized controlled study presenting and comparing bipolar radiofrequency dissection tonsillectomy (BRDT) to cold dissection tonsillectomy (CDT) regarding intra-operative blood loss, operative time, postoperative pain, and postoperative complications including hemorrhage. MATERIALS AND METHODS From January 2004 to March 2005, 200 children planned to undergo tonsillectomy were included in this study. Children were prospectively randomized into two equal groups: bipolar radiofrequency dissection tonsillectomy and cold dissection tonsillectomy. The operative time and intra-operative blood loss were recorded. Children were asked to record their pain on a standardized visual analog scale on days 1, 4, 7, and 14. All children were reviewed on the 4th, 7th, and 14th day after surgery. Postoperative complications were recorded and dealt with. RESULTS There was a shorter operative time (mean 8.5 minutes, P < 0.001) in the radiofrequency group. BRDT showed a decrease of 7 minutes in the mean when compared to the CDT group. The amount of blood lost during BRDT was minimal (mean 13 cc), with a mean difference of 69 cc when compared to CDT (P < 0.001). There was no statistical significant difference in pain score between the two groups except in the first postoperative day where the BRDT demonstrated a statistically significant lower parameters (P < 0.05). No evidence for statistically significant difference between the two groups regarding postoperative complications. CONCLUSION BRDT is a new, easy, and safe technique that offers a complete eradication of the tonsillar disease, short operating time, minimal intra-operative blood loss, and a suitable cost with no additional increase in postoperative pain and hemorrhage when compared to the conventional CDT. Our experience promotes BRDT as the preferred method of tonsillectomy.
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Affiliation(s)
- Sameh M Ragab
- Department of Otolaryngology-Head & Neck Surgery, Tanta Faculty of Medicine and University Hospitals, Tanta, Egypt.
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Lorenz KJ, Kresz A, Maier H. [Hydrodissection for tonsillectomy. Results of a pilot study--intraoperative blood loss, postoperative pain symptoms and risk of secondary hemorrhage]. HNO 2005; 53:423-7. [PMID: 15340701 DOI: 10.1007/s00106-004-1129-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND : Tonsillectomy is one of the most common procedures in head and neck surgery. Various techniques have been developed to reduce the risk of postoperative bleeding and postoperative pain. Water-jet technology has been designed for a gentle dissection of parenchymal organs. We report the results of a first pilot study using the water-jet technique for tonsillectomy.METHODS.: Water-jet-cutting tonsillectomy was compared with conventional blunt dissection tonsillectomy. 60 Patients were stratified in two groups within a preliminary prospective randomised study. Postoperative pain scores, frequency of postoperative bleeding and intraoperative blood loss were documented.RESULTS.: There was no difference in the average duration of the surgical procedure. The intraoperative bloodloss was markedly decreased in water-jet-cutting tonsillectomy. Postoperative bleeding and postoperative pain were decreased in the water-jet-cutting group.CONCLUSION.: The results of this pilot study demonstrate that water-cutting tonsillectomy is associated with less intraoperative bleeding, reduced frequency of postoperative bleeding events and with less postoperative pain.
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Affiliation(s)
- K J Lorenz
- Abteilung für Hals-Nasen-Ohrenheilkunde, Kopf-Halschirurgie, Bundeswehrkrankenhaus Ulm.
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Kirazli T, Bilgen C, Midilli R, Ogüt F, Uyar M, Kedek A. Bipolar electrodissection tonsillectomy in children. Eur Arch Otorhinolaryngol 2005; 262:716-8. [PMID: 16133467 DOI: 10.1007/s00405-004-0774-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2003] [Accepted: 02/03/2004] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to compare bipolar electrodissection tonsillectomy with traditional cold dissection tonsillectomy in the pediatric population. Forty children with recurrent tonsillitis and/or obstructive symptoms were included in the study. The study population was randomly divided into two groups, and the two techniques were compared with regard to operative time, intraoperative and postoperative bleeding and postoperative pain. There were 23 children in the bipolar electrodissection tonsillectomy group (mean age, 8.1 years; range, 5-12 years), and 17 children in the cold dissection tonsillectomy group (mean age, 6.7 years; range, 5-12 years). The average operative times were 15.2+/-8.5 min for bipolar electrodissection tonsillectomy and 29.06+/-13.5 min for cold dissection tonsillectomy (P < 0.05). The blood loss in bipolar electrodissection tonsillectomy and cold dissection tonsillectomy was 5.0+/-4.2 ml and 32.1+/-11.3 ml, respectively (P < 0.05). Postoperative hemorrhage was not observed. Bipolar electrodissection tonsillectomy was less painful the first 30 min postoperatively (P < 0.05). Bipolar electrodissection tonsillectomy in children is a useful technique, with results comparable to traditional cold dissection tonsillectomy.
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Affiliation(s)
- Tayfun Kirazli
- Department of Otorhinolaryngology, Medical School of Ege University, Izmir, Turkey
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