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

Objective: 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 30th min, 1st, 6th, 24th hours and 10th 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 30th min, 1st, 6th, 24th hour and 10th 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.

PDF

___

Soy FK, Dündar R, Yazici H, Kulduk E, Aslan M, Sakarya EU. Bipolar cautery tonsillectomy using different energy doses: Pain and Bleeding. Int J Pediatr Otorhinolaryngol 2014;78:402-6.
Chang H, Hah JH. Comparison of post-tonsillectomy pain with two different types of bipolar forceps: Low temperature quantum molecular resonance device versus high temperature conventional electrocautery. Acta Oto-Laryngologica 2012;132:130-3.
Arbin L, Enlund M, Knutsson J. Post-tonsillectomy pain after using bipolar diathermy scissors or the harmonic scalpel: a randomised blinded study. Eur Arch Otorhinolaryngol 2017;274:2281-5.
Ozkırış M. Comparison of three techniques in pediatric tonsillectomy. Eur Arch Otorhinolaryngol 2012;269:1497-501.
Shirley WP, ALW, Wiatrak BJ, Pharyngitis and adenotonsillar disease, in: 6th edition, in: Flint PW, Haughey BH, Niparko JK, Richardson MA, Lund VJ, Robbins KT, Thomas JR (Eds.), Cummings Otolaryngology-Head and Neck Surgery: Head and Neck Surgery, vol. 3, Elsevier Health Sciences, 2010,p.2796.
G NA, Evaluation and management of pediatric obstructive sleep apnea, in: 6th edition, in: Flint PW, Haughey BH, Niparko JK, Richardson MA, Lund VJ, Robbins KT, Lesperance MM, Thomas JR (Eds.), Cummings Otolaryngology-Head and Neck Surgery: Head and Neck Surgery, vol. 3, Elsevier Health Sciences, 2015, p.2862.
Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs 1988;14:9-17.
Collison PJ, Weiner R. Harmonic scalpel versus conventional tonsillectomy: a double-blind clinical trial. Ear Nose Throat J 2004;83:707-10.
Silveira H, Soares JS, Lima HA. Tonsillectomy: cold dissection versus bipolar electrodissection. Int J Pediatr Otorhinolaryngol 2003;67:345-51.
Guida RA, Mattucci KF. Tonsillectomy and adenoidectomy: an inpatient or outpatient procedure? Laryngoscope 1990;100:491-3.
Weimert TA, Babyak JW, Richter HJ. Electrodissection tonsillectomy. Arch. Otolaryngol. Head Neck Surg1990;116:186-8.
Warnock FF, Lander J. Pain progression, intensity and outcomes following tonsillectomy. Pain 1998;75:37-45.
Dadgarnia MH, Aghaei MA, Atighechi S, Behniafard N, Vahidi MR, Meybodian M, et al. The comparison of bleeding and pain after tonsillectomy in bipolar electrocautery vs cold dissection. Int J Pediatr Otorhinolaryngol 2016;89:38-41.
Heyden HV, Schäfer E, Jecker P, Gosepath J, Mann WJ. Tonsillectomy technique: bipolar scissors vs raspatory: results of a case control study in 138 patients. HNO 2007;55:684-9.
Pang YT. Pediatric tonsillectomy: bipolar electrodissection and dissection/ snare compared. J. Laryngol. Otol 1995;109:733-6.
Raut V, Bhat N, Kinsella J, Toner JG, Sinnathuray AR, Stevenson M. Bipolar scissors versus cold dissection tonsillectomy: a prospective, randomized, multi-unit study. Laryngoscope 2001;111:2178-82.
Atallah N, Kumar M, Hilali A, Hickey S. Post-operative pain in tonsillectomy: bipolar electrodissection technique vs dissection ligation technique. A double-blind randomized prospective trial. J Laryngol Otol 2000;114:667-70.
Kirazli T, Bilgen C, Midilli R, Ogüt F, Uyar M, Kedek A. Bipolar electrodissection tonsillectomy in children. Eur Arch Otorhinolaryngol 2005;262:716-8.
Lowe D, Cromwell DA, Lewsey JD, Copley LP, Brown P, Yung M, et al. Diathermy power settings as a risk factor for hemorrhage after tonsillectomy. Otolaryngol. Head Neck Surg 2009;140:23-8.
Tosun F. Tonsillektomi Ve Adenoidektomi Komplikasyonları. Turkiye Klinikleri J Surg Med Sci 2005;1:26-9.
Interim Guidance on the Use of Diathermy in Tonsillectomy, 2005 Available at: http://www.nice.org.uk (accessed 20.04.05).