A Prospective, Randomized, Double-Blind Study of Coblation versus Dissection Tonsillectomy in Adult Patients

Abstract

This randomized double blind study was conducted prospectively to determine whether coblation tonsillectomy fared better than the conventional dissection method in terms of postoperative pain, bleeding, and rapidity of healing in adult Indian patients undergoing tonsillectomy. Sixty adult patients undergoing tonsillectomy for benign indications were randomized to have one tonsil removed by subcapsular radiofrequency ablation method and the other by conventional dissection method. The operative time and blood loss was noted for each side.Patients were evaluated at 6, 12, 24, 48, 72 h and then on 7th and 20th postoperative day for postoperative pain (by visual analog scale), bleeding, and tonsillar fossa healing. Statistical comparison was done using appropriate tests. The two groups were demographically matched. It took longer to perform the coblation procedure (15 vs 11 min) (P [ 0.05). The operative blood loss on the radiofrequency side was 11 ml, vs 34 ml on the conventional side (P = 0.009). 77% patients said that the coblation side was less painful for the overall 20-day recovery period. There were significant differences seen at 6, 12, 24, 48, and 72 h in terms of postoperative pain scores. Beyond that, the pain was consistently less on the coblation side, but the difference was not significant. There was no case of reactionary or secondary hemorrhage in either arm. The healing took longer on the radiofrequency side. Coblation tonsillectomy is an easy to learn technique with significantly reduced operative blood loss and postoperative pain. Longer operative times maybe further reduced with experience.

Can perioperative acupuncture reduce the pain and vomiting experienced after tonsillectomy? A meta‐analysis

“…Additionally, because of the emetic nature of tonsillectomy, postoperative nausea and vomiting (PONV) can occur in up to 70% of patients; this may contribute to dehydration, or even disruption of the surgical site in severe cases . Therefore, many therapeutic modalities have been used as an effective means of controlling postoperative morbidities in patients . These have included preoperative medications, pre‐ or posttonsillectomy local anesthetics, variations in surgical technique, intraoperative medication, and postoperative pain‐relief medications and antiemetics.…”

Effectiveness of hyaluronic acid in post-tonsillectomy pain relief and wound healing: A prospective, double-blind, controlled clinical study

“…However, the commonly prescribed acetaminophen may not be adequate for post-tonsillectomy pain relief without codeine and at higher doses it may cause hepatic toxicity (5). Therefore, there is an ongoing research on the investigation of effectiveness of many surgical and pharmacological products in post-tonsillectomy pain management (2,4,5,7,9,23,26). Subramayam et al (2) reported their own experience on the use of ATC acetaminophen, dexamethasone and ibuprofen in pain management as no increase in the incidence of inadequate pain control or serious complications.…”

“…In control side, there was a statistically significant difference in patient pain scores in the morning compared to that of afternoon except 6th and 13th postoperative days (Table II). Results indicated that for 6 out of 14 days (at 3rd, 4th, 8th, 9 9th, 10th and 14th days), patients evaluated significantly more post-tonsillectomy pain for non-treated side in the mornings than afternoons (Figure 1). With hyaluronic acid, there was a statistically significant difference in patient pain scores in the morning compared to that of afternoon except 1th and 3rd postoperative days (Table II).…”

“…The morbidity rate caused by postoperative pain and secondary bleeding was reported to be one in 35,000 (5,9). Little is known about the real cause of post-tonsillectomy pain; however the main reasons of this prolonged moderate to severe pain were described to be related with the sensitivity of tonsillar fossae to tissue damage, the disruption of mucosa, the pharyngeal muscle spasms and glossopharyngeal and/or vagal nerve fiber irritation causing inflammation (5,6,9).…”

Postoperative Pain After Tonsillectomy; Comparison Between CO2 Laser Versus Conventional Dissection Tonsillectomy

“…(12) Many literatures focused on the conventional dissection tonsillectomy operation that the healing is more rapid and postoperative pain isless than other studied techniques. (13) Tonsillectomy remains a painful operation often disruptive of family and patients life for more than a week during convalescence whatever the technique.…”