A Comparison of Postoperative Bleeding Incidence between General and Local Anesthesia Tonsillectomies

Abstract

Postoperative bleeding after tonsillectomy is a problem that has earned the respect and cautious attention of the most experienced surgeons. The incidence of postoperative hemorrhage after tonsillectomy, as well as many factors affecting this incidence, has been extensively investigated. A possible factor that has not been well studied as a possible influence in postoperative tonsillectomy bleeding is the choice of anesthetic. A study was completed comparing the incidence of postoperative tonsillectomy bleeding between patients operated on using general anesthetic and local anesthetic. One hundred ninety-two patients consecutively undergoing tonsillectomy at Naval Hospital, Oakland, California, were included in the study. Three of 150 patients (3%) having general anesthesia and 13 of 87 patients (15%) having local anesthesia experienced postoperative bleeding. Possible factors influencing this difference in postoperative bleeding incidence are discussed. The possibility is suggested that surgeons (and previous reports) may underestimate the rates of postoperative bleeding as a result of patients being treated by other than the operating physician.

Surgical revision of hemorrhage in 8388 patients after cold-steel adenotonsillectomies

“…Because of the small number of patients in the latter group, the incidence of PTH in the two groups cannot be compared in our study. In the literature, the incidence of PTH for tonsillectomy under local anesthesia is higher than for tonsillectomy under general anesthesia [20,21].…”

The Steroid Controversy: Where Are We?

“…Specifically, the study reported the experiences of 2 surgeons (430 total procedures): the first used an 8-mg preoperative intravenous dexamethasone dose, injected 5 ml of 1% lidocaine with 1:100,000 epinephrine into the peritonsillar space before making the incision, and packed the fossae with oxymetazoline-soaked tonsil sponges after tonsil removal; the second surgeon used no intravenous dexamethasone and no injected or topical vasoconstrictors. In their discussion, the authors quote data from a study by Kennedy and Strom [57] demonstrating a threefold increase in bleeding in patients who were injected with epinephrine before tonsillectomy (12.5%) versus control patients who were not injected (1.4%). A follow-up study by Blatt [58] reported that the bleeding rate after local tonsillectomy was only 1% when lidocaine 1% is used without epinephrine.…”

Post-tonsillectomy hemorrhage after bipolar diathermy vs. cold dissection surgical techniques in Alahsa region, Saudi Arabia

“…14 However, proponents of the technique state that it is a much faster procedure with minimal intraoperative blood loss and negligible incidence of immediate post-tonsillectomy hemorrhage. 15 Most have found no difference between the two methods, but prefer diathermy because of the decreased operating time needed and drier field that was come to a similar conclusion. 16 Our results were similar to previous studies that have not shown the chronic infection is a risk factor for post-tonsillectomy hemorrhage.…”