The comparison of bleeding and pain after tonsillectomy in bipolar electrocautery vs cold dissection

Dadgarnia, Mohammad Hossein; Aghaei, Mohammad; Atighechi, Saeid; Behniafard, Nasim; Vahidi, Mohammad Reza; Meybodian, Mojtaba; Zand, Vahid; Vajihinejad, Maryam; Ansari, Abdollah

doi:10.1016/j.ijporl.2016.07.022

Cited by 13 publications

(16 citation statements)

References 12 publications

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“…It also has the benefits of reduced intraoperative bleeding and surgical time. 8,9,17 In this study, surgical seniority was associated with shorter duration of surgery and lower incidences of severe pain at 30 minutes. Unfortunately, literature remains inconclusive regarding the difference of perioperative pain and varying degree of surgical experience.…”

Section: Surgical Techniquementioning

confidence: 63%

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Audit of perioperative pain management in paediatric patients following tonsillectomy at a tertiary hospital in Johannesburg

Mogane

Mashinini

Lundgren

2019

South Afr J Anaesth Analg

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Background: Adenotonsillectomy remains one of the most frequently performed surgical procedures in children. Despite improvements in anaesthetic and surgical techniques, severe pain is reported in as many as 25–50% of children. Pain assessment and knowledge of drug pharmacodynamics and pharmacokinetics in the paediatric patient, is a prerequisite for optimal care. Much has been written on perioperative pain management following tonsillectomy. However, no consensus has been reached on what the ideal analgesic regimen should be. This audit is a review of current practice at Chris Hani Baragwanath Academic Hospital. It aims to identify problems and develop possible solutions to improve anaesthetic practice. Methods: A prospective, contextual, descriptive study design using a data collection sheet was used on paediatric patients presenting for tonsillectomy. Results: Eighty-five patients aged three to 12 years of age, with ASA grading I or II, were enrolled in the study. The choice of anaesthetic was variable with a combination of simple analgesics, opioids and adjuvants. This affected postoperative pain scores. Snare dissection and monopolar cautery haemostasis, was the standard surgical technique. Surgical seniority influenced the duration of tonsillectomy, with an effect on postoperative pain scores. Conclusions: Audits are necessary to evaluate what resources are needed to optimise care. The occurrence of pain after tonsillectomy continues to be poorly managed. Appropriate premedication and fasting of clear fluids for no more than two hours, needs to be introduced. Where possible surgical technique should involve bipolar cautery and be limited to less than 45 minutes. A preemptive, multimodal, opioid-sparing anaesthetic should be routinely practised.

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Section: Surgical Techniquementioning

confidence: 63%

“…Cold dissection (scalpel, guillotine and snare) and hot dissection (monopolar and bipolar electrocautery) are commonly described. 8,9 Coblation, laser and the microdebrider are less frequently used. All these techniques are associated with variable postoperative pain intensities.…”

Section: Introductionmentioning

confidence: 99%

Audit of perioperative pain management in paediatric patients following tonsillectomy at a tertiary hospital in Johannesburg

Mogane

Mashinini

Lundgren

2019

South Afr J Anaesth Analg

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“…In this study, the Wong-Baker scale was used to evaluate postoperative pain. Previously, this scale was also used in the evaluation of pain after tonsillectomies in children (13).…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Pain and Operation Time in Children Undergoing a Tonsillectomy using Different Energy Doses of Bipolar Cautery

Kılıç¹

2021

tr-ent

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The aim of the study is to compare the operative time and degree of post-operative pain in children who underwent a tonsillectomy using different energy doses of bipolar cautery and to specify the most appropriate energy dose. Materials and Methods: Patients included in the study were allocated to three groups with 20 in each and each group underwent the operation with 20, 30 and 40 watt energy doses of bipolar cautery. Operative time was recorded for each patient. The Wong-Baker FACES pain rating Scale (WBS) was used in the post-operative period for each patient and the pain severity of the patients was evaluated at post-operative 30 th min, 1 st , 6 th , 24 th hours and 10 th day. The operative times and pain severity of the patients were compared thereafter. Results: A significant difference was not detected between the groups in which 20, 30 and 40 watt bipolar cautery was used (p>0.05). A significant difference was not detected between groups with regard to pain scores at post-operative 30 th min, 1 st , 6 th , 24 th hour and 10 th day (p>0.05). Conclusion:We have compared groups with regard to post-operative pain and operative time according to energy dose of bipolar cautery and detected no statistically significant difference in tonsillectomies conducted with different energy doses. Therefore we consider that energy dose should be as low as possible in tonsillectomies conducted with bipolar cautery.

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“…Kao et al identified several generic and disease-specific questionnaires used to assess tonsillectomy parental reported outcome measures (9). Randomised control trials (RCTs) in recent years have conventionally relied on rates of complications such as haemorrhage and pain (21,23) or objective data such as polysomnography (5,24). However, more recent RCTs use parental reported outcome measure for tonsillectomy as a primary outcome measure (25), reflecting their increasing importance in health care.…”

Section: Clinical Applications and Future Directions Of Researchmentioning

confidence: 99%

Outcomes using the T-14 symptom score for tonsillectomy in an Australian paediatric population

Lam¹,

Woods²,

Du³

et al. 2019

Aust J Otolaryngol

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Background: Quality of life (QoL) outcomes after paediatric tonsillectomy can be assessed with diseasespecific patient reported outcome measures. Our aim was to assess a modified T-14 Paediatric Throat Disorders Outcome Test in an Australian paediatric population undergoing tonsillectomy. Methods: A consecutive case series was conducted in children (aged 1-16 years) undergoing tonsillectomy over a period of 15 months. T-14 questionnaires administered to the caregivers of the child pre-operatively and post-operatively (n=45) within 6-8 weeks of the procedure were included for statistical analysis. Preand post-operative T-14 scores were compared and analysed according to surgical indication [either sleep disordered breathing (SDB), recurrent tonsillitis, or both] and complications with non-parametric tests. Results: Post-operative scores demonstrated a global improvement for SDB (n=22), recurrent tonsillitis (n=12) and for both (n=11) indications (P<0.0001 each). High compliance with the T-14 was obtained with parents completing the questionnaire pre-and post-operatively. T-14 scores did not improve in 2 patients who had rhinitis and otitis media at the time of post-operative testing. Conclusions: The modified T-14 questionnaire is suitable for measuring parental reported health outcomes for paediatric throat disorders in patients undergoing tonsillectomy in the Australian population. The T-14 questionnaire demonstrates improvement in parental perception of their child's symptoms after tonsillectomy. It is easy to administer producing a high compliance rate.

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The comparison of bleeding and pain after tonsillectomy in bipolar electrocautery vs cold dissection

Cited by 13 publications

References 12 publications

Audit of perioperative pain management in paediatric patients following tonsillectomy at a tertiary hospital in Johannesburg

Audit of perioperative pain management in paediatric patients following tonsillectomy at a tertiary hospital in Johannesburg

A Comparison of Pain and Operation Time in Children Undergoing a Tonsillectomy using Different Energy Doses of Bipolar Cautery

Outcomes using the T-14 symptom score for tonsillectomy in an Australian paediatric population

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