Pain scores and recovery post tonsillectomy: intracapsular versus extracapsular coblation

Junaid, Montasir; Sood, S; Walijee, Hussein; Dorgham, J; S, De

doi:10.1017/s0022215119001610

Cited by 6 publications

(15 citation statements)

References 11 publications

(12 reference statements)

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“…Key characteristics for each included study are presented in Table 1 . The included studies consisted of 3 RCTs using a with‐in patient design, 29 , 30 , 38 5 RCTs using a between‐patient design, 32 , 33 , 34 , 41 , 45 1 prospective cohort study, 40 and 8 retrospective cohort studies. 31 , 35 , 36 , 37 , 39 , 42 , 43 , 44 Across the 17 studies, a total of 1996 patients underwent CIT.…”

Section: Resultsmentioning

confidence: 99%

“… 31 , 35 , 36 , 37 , 39 , 42 , 43 , 44 Across the 17 studies, a total of 1996 patients underwent CIT. The comparator arms included total tonsillectomy using plasma ablation (9 studies, 29 , 30 , 31 , 34 , 35 , 36 , 40 , 41 , 43 n = 1100), electrocautery (4 studies, 32 , 33 , 38 , 45 n = 155), cold steel (2 studies, 37 , 44 n = 77), electrocautery or plasma ablation (1 study, 42 n = 1800), any nonplasma ablation device (1 study, 35 n = 1216) and nondefined device (1 study, 39 n = 217).…”

Section: Resultsmentioning

confidence: 99%

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Intracapsular Tonsillectomy Using Plasma Ablation Versus Total Tonsillectomy: A Systematic Literature Review and Meta‐Analysis

2023

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Objective To determine whether intracapsular tonsillectomy, using plasma ablation, results in differences in postoperative patient outcomes to total tonsillectomy. Data Sources A systematic review of two databases (Embase and PubMed) was conducted in March 2022 to identify published English‐language randomized controlled trials and observational studies which provided a comparison between intracapsular tonsillectomy, using plasma ablation, and total tonsillectomy. Review Methods Qualitative synthesis and meta‐analysis were used to compare outcomes between techniques. Results Seventeen studies were identified for inclusion. Across these, 1996 and 4565 patients underwent intracapsular and total tonsillectomy, respectively. Studies included 8 randomized controlled trials, 1 prospective cohort study, and 8 retrospective cohort studies. Time to pain free, time on analgesia, time to normal diet, and time to normal activity were significantly shorter with intracapsular tonsillectomy by on average 4.2 (95% confidence interval [CI] 1.5‐5.9; p < .0001), 4.1 (95% CI 2.7‐5.4; p < .0001), 3.5 (95% CI 1.7‐5.4; p = .0002) and 2.8 (95% CI 1.6‐4; p < .0001) days, respectively. Risk of posttonsillectomy hemorrhage was significantly lower following intracapsular tonsillectomy (relative risk [RR] 0.36; 95% CI 0.16‐0.81; p = .0131); risk of posttonsillectomy hemorrhage requiring surgical management was lower but failed to reach significance (RR 0.52; 95% CI 0.19‐1.39; p = .19). Conclusion Intracapsular tonsillectomy using plasma ablation has similar efficacy in managing indications for tonsil surgery to total tonsillectomy while significantly reducing the postoperative morbidity and likelihood of posttonsillectomy hemorrhage experienced by patients, allowing them to return to their normal life faster.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Intracapsular Tonsillectomy Using Plasma Ablation Versus Total Tonsillectomy: A Systematic Literature Review and Meta‐Analysis

2023

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“…We also excluded the trials in which tonsillotomy, intracapsular tonsillectomy, or partial tonsillectomy was performed because these surgeries can affect the occurrence of postoperative complications. For instance, recent studies 22 , 23 have shown that, compared to extracapsular tonsillectomy, intracapsular tonsillectomy significantly reduced postoperative pain and the rate of secondary postoperative bleeding. Finally, the trials that used cold steel for dissection and diathermy to hemostasis were also excluded.…”

Section: Methodsmentioning

confidence: 99%

Plasma Ablation vs Other Hot Techniques for Tonsillectomy: A Meta‐analysis

Guo

Xiao

Zhou

et al. 2020

Otolaryngol.--head neck surg.

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Objective To evaluate whether plasma ablation tonsillectomy is superior to other hot techniques in reducing postoperative morbidity. Data Sources The databases of PubMed, EMBASE, and Web of Science were used to search the literature, from inception to January 2, 2020. Randomized controlled trials (RCTs) that compared plasma ablation tonsillectomy with any other hot techniques were eligible. Review Methods A modified Cochrane tool was used to assess the risk of bias. The standardized mean difference (SMD) and 95% confidence interval (CI) were used to estimate pooled effects of postoperative pain, and the risk ratio (RR) was used for postoperative bleeding. Subgroup analysis was prespecified to explore the source of heterogeneity. The evidence quality of each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results A total of 15 RCTs were included (n = 1293). Comparing with other hot techniques, plasma ablation tonsillectomy may cause less pain on postoperative day 7 (SMD, −0.53; 95% CI, −0.84 to −0.23). However, the magnitude of the difference may be clinically meaningless. There were no significant differences not only in terms of postoperative pain on day 1 and day 3 but also in the incidence of postoperative bleeding, reoperation hemostasis, and return to normal diet and activities between the 2 groups. Conclusion There is still substantial uncertainty on postoperative pain, bleeding, and recovery. The current evidence is insufficient to demonstrate that plasma ablation is superior to other hot techniques for tonsillectomy.

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“…The usual indications to perform tonsillectomy can be divided into two main categories: recurrent tonsillitis and adenotonsillar hypertrophy causing airway obstruction and sleep-disordered breathing [2]. In recent years, intracapsular tonsillectomy (partial tonsillectomy) has emerged as an alternative surgical option to total tonsillectomy for OSA in children, with possible advantages related to lesser operative blood loss and postoperative pain [3][4][5][6]. Various techniques of tonsillectomy have been proposed, ranging from hot instrumentation as laser and monopolar cautery, mild thermal exposure as coblation and radiofrequency, and cold techniques like the classic knife or powered instrumentation with a microdebrider [7].…”

Section: Introductionmentioning

confidence: 99%

Thermal injury in tonsils and its relation to postoperative pain—a histopathological and clinical study

Obeidat

Martins

Aloqaily

et al. 2021

Egypt J Otolaryngol

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Objectives The aim of this study was to compare thermal injury and depth of necrosis of using different monopolar power settings in partial tonsillectomy and correlate the results with the postoperative pain score. Results The study included a total of 15 patients with mean of age of 5.7 ± 2.57 years. The mean depth of injury was significantly higher for the 25 W side (0.973 ± 0.613) versus the 15 W side (0.553 ± 0.218) (p = 0.023). The postoperative pain score showed no significant differences between both sides. Conclusion The histopathologic depth of thermal injury is significantly higher with the 25 W monopolar microdissection in comparison to the 15 W; however, it does not seem to correlate with the postoperative pain level. Apparently, power settings of 25 W can be safely used for pediatric intracapsular tonsillectomies, without added postoperative morbidity despite the deeper tissue injury observed in the tonsil.

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Pain scores and recovery post tonsillectomy: intracapsular versus extracapsular coblation

Cited by 6 publications

References 11 publications

Intracapsular Tonsillectomy Using Plasma Ablation Versus Total Tonsillectomy: A Systematic Literature Review and Meta‐Analysis

Intracapsular Tonsillectomy Using Plasma Ablation Versus Total Tonsillectomy: A Systematic Literature Review and Meta‐Analysis

Plasma Ablation vs Other Hot Techniques for Tonsillectomy: A Meta‐analysis

Thermal injury in tonsils and its relation to postoperative pain—a histopathological and clinical study

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