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Double-blind, randomised, controlled study of post-operative pain in children undergoing radiofrequency tonsillotomy versus laser tonsillotomy

Published online by Cambridge University Press:  12 April 2010

K Stelter ,
R de la Chaux ,
M Patscheider  and
B Olzowy
K Stelter*
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Centre, Ludwig Maximilians University, Munich, Germany
R de la Chaux
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Centre, Ludwig Maximilians University, Munich, Germany
M Patscheider
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Centre, Ludwig Maximilians University, Munich, Germany
B Olzowy
Affiliation:
Department of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Centre, Ludwig Maximilians University, Munich, Germany
*
Address for correspondence: Dr Klaus Stelter, Dept of Otorhinolaryngology, Head and Neck Surgery, Grosshadern Medical Centre, Ludwig Maximilians University, Marchioninistr 15, 81377 Munich, Germany. Fax: +49 89 7095 6869 E-mail: [email protected]
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Abstract

Introduction:

In the last decade tonsillotomy has come into vogue again, whereas the number of tonsillectomies is decreasing rapidly. Currently, most tonsils are reduced by utilise electrosurgery, radiofrequency or carbon dioxide laser. However, it is not clear whether radiofrequency tonsillotomy is as effective as laser or other surgical techniques in respect of post-operative pain and haemorrhage.

Material and methods:

A prospective, randomised, double-blinded, controlled, clinical study was conducted in the otorhinolaryngology department of Ludwig Maximilians University, Munich, Germany. Twenty-six children with tonsillar hypertrophy were included. Exclusion criteria were: history of peritonsillar abscess, previous tonsil surgery, tonsillitis within two weeks, pain before surgery, psychiatric illness, asymmetrical tonsils, chronic analgesic usage, bleeding disorders and other surgical procedures during the same operation. Tonsillotomy was performed on one side with radiofrequency and on the other side with a carbon dioxide laser. All procedures were performed by a single surgeon, under general anaesthesia. A visual analogue scale was used to measure patients' pain on each side, administered by a ‘blinded’ nurse on the three post-operative mornings and evenings, within the hospital.

Results:

There was no difference in post-operative pain scores or haemorrhage, comparing laser versus radiofrequency tonsillotomy. Patient's overall reported pain was very modest compared with post-tonsillectomy pain. No haemorrhage or other adverse effects were observed.

Keywords

TonsillectomyLaserRadiofrequency SurgeryPainIntraindividual designVASPostonsillotomy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 8 , August 2010 , pp. 880 - 885
Copyright
Copyright © JLO (1984) Limited 2010

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References

1 Younis, RT, Lazar, RH. History and current practice of tonsillectomy. Laryngoscope 2002;112:3–5CrossRefGoogle ScholarPubMed
2 Homer, JJ, Frewer, JD, Swallow, J, Semple, P. An audit of post-operative analgesia in children following tonsillectomy. J Laryngol Otol 2002;116:367–70CrossRefGoogle ScholarPubMed
3 Stelter, K, Hempel, JM, Berghaus, A, Andratschke, M, Luebbers, CW, Hagedorn, H. Application methods of local anaesthetic infiltrations for postoperative pain relief in tonsillectomy: a prospective, randomised, double-blind, clinical trial. Eur Arch Otorhinolaryngol 2009;266:1615–20CrossRefGoogle ScholarPubMed
4 Unkel, C, Lehnerdt, G, Schmitz, KJ, Jahnke, K. Laser-tonsillotomy for treatment of obstructive tonsillar hyperplasia in early childhood: a retrospective review. Int J Pediat Otorhinolaryngol 2005;69:1615–20CrossRefGoogle ScholarPubMed
5 Pfaar, O, Spielhaupter, M, Schirkowski, A, Wrede, H, Mosges, R, Hormann, K et al. Treatment of hypertrophic palatine tonsils using bipolar radiofrequency-induced thermotherapy (RFITT). Acta Otolaryngol 2007;127:1176–81CrossRefGoogle ScholarPubMed
6 Arya, AK, Donne, A, Nigam, A. Double-blind randomized controlled study of coblation tonsillotomy versus coblation tonsillectomy on postoperative pain in children. Clin Otolaryngol 2005;30:226–9CrossRefGoogle ScholarPubMed
7 Leinbach, RF, Markwell, SJ, Colliver, JA, Lin, SY. Hot versus cold tonsillectomy: a systematic review of the literature. Otolaryngol Head Neck Surg 2003;129:360–4CrossRefGoogle ScholarPubMed
8 Parsons, SP, Cordes, SR, Comer, B. Comparison of posttonsillectomy pain using the ultrasonic scalpel, coblator, and electrocautery. Otolaryngol Head Neck Surg 2006;134:106–13CrossRefGoogle ScholarPubMed
9 Isaacson, G. Pediatric intracapsular tonsillectomy with bipolar electrosurgical scissors. Ear Nose Throat J 2004;83:702, 704–2, 706CrossRefGoogle ScholarPubMed
10 Huber, K, Sadick, H, Maurer, JT, Hormann, K, Hammerschmitt, N. Tonsillotomy with the argon-supported monopolar needle – first clinical results [in German]. Laryngorhinootologie 2005;84:671–5Google Scholar
11 Bitar, MA, Rameh, C. Microdebrider-assisted partial tonsillectomy: short- and long-term outcomes. Eur Arch Otorhinolaryngol 2008;265:459–63CrossRefGoogle ScholarPubMed
12 Anand, A, Vilela, RJ, Guarisco, JL. Intracapsular versus standard tonsillectomy: review of literature. J La State Med Soc 2005;157:259–61Google Scholar
13 Koltai, PJ, Solares, CA, Koempel, JA, Hirose, K, Abelson, TI, Krakovitz, PR et al. Intracapsular tonsillar reduction (partial tonsillectomy): reviving a historical procedure for obstructive sleep disordered breathing in children. Otolaryngol Head Neck Surg 2003;129:532–8CrossRefGoogle ScholarPubMed
14 Ashbach, MN, Ostrower, ST, Parikh, SR. Tonsillectomy techniques and pain: a review of randomized controlled trials and call for standardization. ORL J Otorhinolaryngol Relat Spec 2007;69:364–70CrossRefGoogle Scholar
15 Ericsson, E, Ledin, T, Hultcrantz, E. Long-term improvement of quality of life as a result of tonsillotomy (with radiofrequency technique) and tonsillectomy in youths. Laryngoscope 2007;117:1272–9CrossRefGoogle ScholarPubMed
16 Hultcrantz, E, Linder, A, Markstrom, A. Long-term effects of intracapsular partial tonsillectomy (tonsillotomy) compared with full tonsillectomy. Int J Pediatr Otorhinolaryngol 2005;69:463–9CrossRefGoogle ScholarPubMed
17 Ericsson, E, Graf, J, Hultcrantz, E. Pediatric tonsillotomy with radiofrequency technique: long-term follow-up. Laryngoscope 2006;116:1851–7Google Scholar
18 Unkel, C, Lehnerdt, G, Schmitz, KJ, Jahnke, K. Laser-tonsillotomy for treatment of obstructive tonsillar hyperplasia in early childhood: a retrospective review. Int J Pediatr Otorhinolaryngol 2005;69:1615–20CrossRefGoogle ScholarPubMed
19 Burton, MJ, Doree, C. Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev 2007;(3):CD004619CrossRefGoogle ScholarPubMed
20 Adnan, MT, Abdel-Fattah, MM, Makhdoom, NK, El-Khouly, AA. Does the use of radiofrequency ultrasonic dissector in tonsillectomy have a beneficial effect over the use of laser? Saudi Med J 2008;29:1775–8Google ScholarPubMed
21 Williamson, A, Hoggart, B. Pain: a review of three commonly used pain rating scales. J Clin Nurs 2005;14:798–804CrossRefGoogle Scholar
22 Sloman, R, Wruble, AW, Rosen, G, Rom, M. Determination of clinically meaningful levels of pain reduction in patients experiencing acute postoperative pain. Pain Manag Nurs 2006;7:153–8CrossRefGoogle ScholarPubMed
23 Mohamed, SK, Ibraheem, AS, Abdelraheem, MG. Preoperative intravenous dexamethasone combined with glossopharyngeal nerve block: role in pediatric postoperative analgesia following tonsillectomy. Eur Arch Otorhinolaryngol 2009;266:1815–19CrossRefGoogle ScholarPubMed
24 Sorensen, WT, Wagner, N, Aarup, AT, Bonding, P. Beneficial effect of low-dose peritonsillar injection of lidocaine-adrenaline before tonsillectomy. A placebo-controlled clinical trial. Auris Nasus Larynx 2003;30:159–62CrossRefGoogle ScholarPubMed
25 Somdas, MA, Senturk, M, Ketenci, I, Erkorkmaz, U, Unlu, Y. Efficacy of bupivacaine for post-tonsillectomy pain: a study with the intra-individual design. Int J Pediatr Otorhinolaryngol 2004;68:1391–5CrossRefGoogle Scholar