Otorhinolaryngology-Head and Neck Surgery

2021

Background: Tonsillectomy is commonly performed otolaryngological operation. It can cause considerable pain in children. Different types of tonsillectomy are described in the literature. Modified technique of bipolar tonsillectomy can significantly reduce postoperative pain. Objective: This study aimed to assess postoperative pain in children after modified bipolar tonsillectomy. Methods: 120 patients, age 6-12 years, were selected for this study. Indication for tonsillectomy was a history of recurrent tonsillitis. Spetzler-Malis bipolar forceps (tip size 0.5 mm) with low energy (5 W) was applied. We tried to preserve the pillars as much as possible. Pain was assessed on 1st, 3rd, 5th, 7th and 10th postoperative days. The pain was evaluated with visual analogue scale (VAS). Results: On the first day of the operation 114 patients (95%) had no pain, 6 patients (5%) had mild pain, on the third postoperative day in 95% pain was mild, in 5% pain was moderate, on the fifth postoperative day pain was mild in 84 patients (70%), 36 patients (30%) had moderate pain, on the seventh postoperative day 95% of patients did not present pain, 5% of patients had mild pain. On the tenth postoperative day no one had pain. None of them presented nausea, vomiting, otalgia or severe pain. Conclusion: Low energy electrocautery, direct cautery to the tonsillar bed and preservation of the mucosa are all effective measures that have diminished post-op pain in bipolar dissection.

IRJPMS, 2022

Background: Coblation tonsillectomy has shown promising findings compared to the bipolar method regarding postoperative pain in the first two weeks and readmission rate due to bleeding or infection in addition to median operation time. Aim: To compare the surgical outcome between coblation and bipolar surgical techniques for tonsillectomy. Methods: This is a retrospective analysis of a prospectively maintained database. One hundred patients, of both sexes and with different ages ranging between 3 and 10 years, were assigned for standard tonsillectomy at Queen Rania Pediatrics Hospital and randomized using sealed envelopes into two groups, each of which included 50 patients, with a minimum follow up of 14 days. Data were collected to assess postoperative pain in the first two weeks, the return to a typical eating routine, readmission rate due to complications such as hemorrhage or infection, and median operation time. Group A included patients who underwent tonsillectomy by coblation technique whereas group B included patients who underwent tonsillectomy by bipolar technique. Postoperative pain was evaluated using the Wong-Baker Faces pain descriptive scale (0-5). Results: Patients in group A had lower average pain scores (3.1,4.3) than patients in group B (4.2,5.2) at day one(P<0.05) and day five (P<0.05) post-operatively. Both groups had very close average pain scores at day ten post-operatively (2.6 and 2.8, respectively. P>0.05). No significant difference in average pain scores was observed at the end of the postoperative fourteen days between both groups A and B (0.15, 0.17, respectively; P>0.05). The readmission rate was lower in group A than in group B. On the other hand, lower median operation time was reported using the bipolar method. Conclusion: Coblation is a useful surgical technique for tonsillectomy that could reduce postoperative pain scores. Lower postoperative complications such as hemorrhage, poor oral intake, and infection were observed among patients who underwent tonsillectomy by coblation technique. Nevertheless, the median operation time for bipolar tonsillectomy was shorter.

International Journal of Pediatric Otorhinolaryngology, 2014

2015

Introduction: Tonsillectomy is one of the most common surgeries all over the world and is performed by various methods. This study aimed to investigate the complications of bipolar electrocautery method of tonsillectomy. Methods: This cross-sectional study was performed on 234 patients, 114 female and 120 male individuals. The mean age of the patients was 12.2±8.3 (min=3 and max=58.2) years. Some parameters including duration of surgery, intraoperative blood loss, postoperative hemorrhage, severity of pain were measured 4 and 24 hours after operation. The data were analyzed by SPSS software (Version 15) using Mann-Whitney, Kruskal-Wallis and Spearman tests. P values less than 0.05 were considered significant. Results: In our study, the mean duration of surgery was 12.7±4.5 minutes, mean intraoperative blood loss was 36.6±10.8 ml, and postoperative hemorrhage was observed in 3.4 % of patients. The mean pain scores 4 hours after operation were 2.1±0.7 and 2.7±0.8 for age groups below ...

European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2017

To compare the postoperative pain following bipolar diathermy scissors tonsillectomy (higher temperature dissection) with harmonic scalpel tonsillectomy (lower temperature dissection). Sixty patients aged 7-40 years planned for tonsillectomy with no other concurrent surgery were randomised to either bipolar diathermy scissors or harmonic scalpel as surgical technique. Blinded to the surgical technique, the patients recorded their pain scores (VAS, 0-10) at awakening and the worst pain level of the day in the postoperative period. All intake of pain medication was also recorded. No statistically significant differences were found between the two groups regarding postoperative pain levels or consumption of pain medication. Usage of the harmonic scalpel does not render less postoperative pain following tonsillectomy when compared with usage of the bipolar diathermy scissors.

Health Renaissance, 2014

Background: Tonsillectomy is one of the most commonly performed operations in otolaryngology. There are many proven methods of tonsillectomy, including cold dissection and bipolar electrocautery. Objective: To compare bipolar elecrocautery tonsillectomy with cold dissection method in pediatric age groups. Methods: Single blind controlled study to compare bipolar technique against the conventional dissection/snare technique. Results: The average amount of bleeding on electrocautery side was 4.07ml and on the cold dissection side was 14.58 ml. The mean time of operation for electrocautery and cold dissection was 12.04 and 16.57 minutes respectively. On the second post operative day, 35% of the patients complained of pain on the cauterized side, 30% complained of more pain on the dissection side while 35 % experienced equal pain on both sides. Post-operative complication such as hemorrhage was not seen in both the techniques employed. Conclusion: In the present study, bipolar diathermy tonsillectomy had advantages in having less post-operative time and blood loss intraoperatively but patients experience slightly more pain than cold dissection.

International journal of pediatric otorhinolaryngology, 2008

To compare operative time, intraoperative and postoperative bleeding and pain using two different techniques for tonsillectomy: electronic molecular resonance bipolar tonsillectomy and blunt dissection tonsillectomy. From January 2005 to December 2006, a prospective, randomised study was performed in 800 children, aged from 3 to 10 years, admitted to the ENT (Ear Nose Throat) Unit of Giannina Gaslini Institute, Genoa, Italy to undergo tonsillectomy. Patients were randomised into two surgical groups, Group A (electronic molecular resonance tonsillectomy, EMRBT) and Group B (blunt dissection tonsillectomy). Operative time, intraoperative blood loss and postoperative complications were recorded. During 10 days after surgery, children and their parents were also asked to provide a rating of the patients&#39; current pain intensity using a visual analogue scale. In this period, the parents were also asked to note the analgesic drugs administered. Duration of surgery and blood loss were s...

Journal of Gandaki Medical College-Nepal

Introduction: Tonsillectomy is the most commonly performed surgeries in otolaryngology. Despite the evolution in surgical and anaesthetic techniques, pain and bleeding are still the most important surgical complications. This study was done to compare the pain and bleeding following tonsillectomy using monopolar and bipolar cautery techniques in our population. Methods: It was a prospective, longitudinal study done over a period of one year at Gandaki Medical College, Pokhara, Nepal. Total 45 patients who underwent tonsillectomy by either monopolar or bipolar cautery were included in the study and assessed for postoperative pain and haemorhage. The data was entered in Microsoft Excel and further analysis done by statistical package for the social sciences 16.0. The association of variables was be tested by Chi square test and p-value of less than 0.05 was considered significant. Confidence interval was be kept at 95%. Results: Out of the 45 patients who underwent tonsillectomy, 35.5...

International Archives of Otorhinolaryngology, 2014

Evaluate the use of cooling the oropharynx intraoperatively to reduce postoperative pain in tonsillectomy with the use of monopolar electrocautery in children. Literature Review Operative tonsillectomy pain is basically characterized by local tissue injury, which releases histamine and inflammatory

Annals of Clinical and Analytical Medicine, 2012

Bu çalışmada tonsiller hipertrofi nedeni ile solunum yolu obstrüksiyonu olan çocuklarda uygulanan bipolar elektrokoter tonsillektomi ve klasik tonsillektomi tekniklerinin ameliyat sırasında ve sonrasındaki klinik sonuçları karşılaştırılmalı olarak değerlendirildi. Gereç ve Yöntem: Bipolar elektrokoter ile tonsillotomi yapılan 31 çocuk hasta ile konvansiyonel soğuk disseksiyon tonsillektomi yapılan 45 çocuk hasta karşılaştırıldı. Postoperatif ağrı skorları erken postoperatif dönemde 'Modifiye Hannalah Skalası' ile ve geç postoperatif dönemde 'Vizüel Analog Skoru' ile ölçüldü. Bu iki grup operasyon sırasındaki kan kaybı, operasyon süresi, oral alım süresi, ağrı kesici alımı, iyileşme zamanı ve postoperatif ağrı skorları açısından karşılaştırıldı. Bulgular: Bipolar elektrokoter ile tonsillotomi yapılan çocuklarda iyileşme sürecinde konvensiyonel tonsillektomi uygulanan gruba göre belirgin olarak daha az ağrı olduğu görüldü. Bipolar elektrokoter tonsillotomi yapılan grupta intraoperatif kan kaybı, operasyon süresi, oral alım süresi, ağrı kesici alımı, iyileşme süresi ve postoperatif ağrı skorları konvansiyonel tonsillektomi uygulanan gruba göre daha az olduğu tespit edildi. Sonuç: Bipolar elektrokoter tonsillotominin obstrüktif uyku apnesi olan çocukların iyileşmesinde konvansiyonel tonsillektomi ile eşit etkinlikte ve güvenirlikte olduğu görüldü. Bipolar elektrokoter tonsillotomi yöntemi ile postoperatif ağrı daha az olmakta, yaşam kalitesini arttırmakta ve iyileşme sürecini kısaltmaktadır. Bu nedenlerle bipolar elektrokoter tonsillotomi yöntemi çocuklarda konvansiyonel tonsillektomiden daha kabul edilebilir bir yöntem olabilir.