Autologous fibrin sealant reduces pain after tonsillectomy

Objectives/Hypothesis: Pain is a major cause of morbidity after tonsillecto my. Although various efforts have been made to reduce pain, the use of oral analgesics, which can have adverse side effects, remains the standard of c are. It is hypothesized that fibrin sealant, used to achieve hemostasis and enhance healing in many surgical procedures, might help decrease pain afte r this operation. Study Design: A prospective, randomized, blinded study wa s performed on 20 children aged 5 to 17 years who were undergoing tonsillec tomy, to evaluate the efficacy of FIBRIN SEALANT in reducing postoperative pain. Methods: All patients pre-donated 40 mL of blood from which autologou s concentrated fibrinogen was prepared by cryoprecipitation. In the fibrin sealant group, fibrinogen and topical bovine thrombin were sprayed onto the surgical site to form fibrin sealant at the conclusion of tonsillectomy. T he 10 patients in the control group (C) received no fibrin sealant. Patient s rated their level of pain immediately after surgery and at regular interv als for 3 days after surgery using the Wong-Baker Faces Pain Rating Scale ( 1-6). Emesis, postoperative bleeding, medications, and adverse events were also evaluated. Results: At 7:00 P.M. On postoperative day (POD) 0, the mea n +/-; SD fibrin sealant group pain score (2.9 +/- 0.41 units) was signific antly lower than for the C group (4.1 +/- 0.43 units; P less than or equal to .05). There was also a trend in favor of less pain in the fibrin sealant group at 7:00 P.M. on POD 1, with a mean of 3.5 +/- 0.43 units versus 2.4 +/- 0.48 units for C (P = .15). The odds of a patient in C experiencing eme sis were 8.16 times higher, (P less than or equal to .05) than for patients in the fibrin sealant group. Conclusions: Fibrin sealant significantly red uced pain the evening after pediatric tonsillectomy and also decreased the chance of experiencing emesis. Thus fibrin sealant may be clinically useful as an adjunct to tonsillectomy.