Postoperative tonsillectomy pain in pediatric patients - Electrocautery (hot) vs cold dissection and snare tonsillectomy - A randomized trial

Objective: To determine the effect of the method of tonsillectomy on postop erative pain in pediatric patients. Design: Prospective, randomized, single-blind, controlled clinical trial. Setting: A university pediatric hospital in Aberdeen, Scotland. Patients: A volunteer sample of 54 children, aged 3 to 12 years, with recur rent tonsillitis or symptomatic adenotonsillar hypertrophy. Two patients wi thdrew consent. Interventions: Twenty-six children underwent a nonelectrical (ie, cold) dis section tonsillectomy with cold steel instruments. 5 of whom also had adeno idectomy hv curettage. Monopolar diathermy forceps were used fdr tonsillar bed hemostasis. Twenty-four children had electrocautery (ie, hot) dissectio n tonsillectomy, 7 of whom underwent adenoidectomy by curettage without a s uction coagulator. Main Outcome Measures: Postoperative analgesic consumption, time to regain normal diet and activity levels, and complications. Results: Patients who underwent hot dissection tonsillectomy showed no diff erence in time to first drink or analgesic use within the first 24 postoper ative hours compared with children undergoing cold nonelectrical dissection tonsillectomy. The hot dissection tonsillectomy group took 7.5 (95% confid ence interval [CI], 1-14.1) more doses of analgesics than the cold dissecti on group over the next 12 days (P<.05). The hot dissection tonsillectomy gr oup took 2.5 more days than the cold dissection tonsillectomy group to rega in normal diet (P<.05). Thirteen children (54%: 95% CI, 34-74) in the hot d issection tonsillectomy group and 6 (23%; 95% CI, 7-39) in the cold dissect ion tonsillectomy group sought outpatient care for throat pain, otalgia, po or diet, pyrexia, and/or bleeding (P<.05). Throat pain delayed in onset or of prolonged duration affected 9 children (38%; 95% CI, 19-57) in the hot d issection tonsillectomy group as opposed to 3 children (12%;: 95% CI, 0-24) in the cold dissection tonsillectomy group (P<.05). Conclusion: Hot dissection tonsillectomy increases morbidity in pediatric p atients in the recovery period following hospital discharge.