Post-Tonsillectomy Pain:Is Cold Steel Dissection Method or Bipolar Diathermy Dissection Method is less Painful?
DOI:
https://doi.org/10.52206/jsmc.2024.14.2.804Abstract
Background: Pain is one of the sequel of tonsillectomy, as reported in various studies. Tonsillectomy can be done by various methods, so aim of the present study is to evaluate pain of tonsillectomy comparing cold steel dissection method with bipolar diathermy method.
Objective: To evaluate post-tonsillectomy pain comparing cold steel dissection method with bipolar diathermy method.
Material and Methods: This prospective, randomized, controlled trial was conducted in ENT Department, from 18th January 2021 to January 30th 2022. Post tonsillectomy pain was measured by using visual analogue scale which consists of a 10 cm line with score of 10 means worse pain and score of zero means no pain. In this study a total sample size was 186 patients (i.e. 93 in each group), who were observed by taking the following parameters. Mean ± SD of group A (bipolar diathermy group) = 2.27 ± 1.25. Mean ± SD of group B (cold steel dissection group) = 1.59 ± 1.59. Confidence interval (2-sided) =95%. Power=90%. More over consecutive (nonprobability) sampling technique was used for sample collection.
Results: In bipolar dissection group (38%) patients were male and (62%) patients were female. Where as in cold dissection group (40%) patients were male and (60%) patients were female. The mean pain score at 24 hours, 2ndpost operative day, 7th post operative day among two groups was analyzed. In bipolar dissection group, mean pain score at 24 hours was 3.5 ± 0.66, mean pain score at 2nd post operative day was 2.93 ± 0.73 and mean pain score at 7th post operative was 1.59 ± 1.02. Where as in cold dissection group, mean pain score at 24 hours was 3.33 ± 0.53 with a p value of 0.0543, mean pain score at 2ndpost operative day was 2.34 ± 0.60 with a p value of 0.0001and mean pain score at 7th post operative was 1.46 ± 0.82 with a p value of 0.3394.
Conclusion: Our study concludes that mean pain score is less in cold steel dissection tonsillectomy as compared to bipolar diathermy tonsillectomy.
Keywords: Analogue pain scale, Surgical Diathermy, Tonsillectomy.
References
Álvarez Palacios I, González-Orús Álvarez-Morujo R, Alonso Martínez C, Ayala Mejías A, Arenas Brítez O. Postoperative pain in adult tonsillectomy: is there any difference between the technique? Indian Journal of Otolaryngology and Head & Neck Surgery 2017 Jun;69:187-93. https:// DOI: https://doi.org/10.1007/s12070-017-1058-9
Khanam A, Akhtar G, Hossain F, Chowdhury NN, Rahman MA. Pattern of Otolaryngological Diseases among Paediatric Population Attending ENT OPD in a Tertiary Care Centre, Dhaka. Delta Medical College Journal 2017 Feb 4;5(1):30-4.
Naeemi M. Iincidence of post-operative nausea and vomiting in laparoscopic cholecystectomy with a single dose of preoperative dexamethasone. Biological and Clinical Sciences Research Journal 2023 Oct 27;2023(1):485-89. DOI: https://doi.org/10.54112/bcsrj.v2023i1.485
Kundu SR, Islam H, Kundu SK, Rahman MM, Khatun MK. The Magnitude of Postoperative Nausea and Vomiting: A Descriptive Study in Rajshahi Medical College Hospital, Bangladesh. Sch J App Med Sci 2022 Nov;11:1898-902. DOI: https://doi.org/10.36347/sjams.2022.v10i11.015
Rakesh S, AnandTS,Payal G, Pranjal K. A prospective randomized double blind study of cobalation versus dissection tonsillectomy in adult patients. Ind J Otolaryngo Head Neck surg. July- sept 2012; 64(3): 290-4. DOI: https://doi.org/10.1007/s12070-011-0355-y
Mahmutozkeris. Comparison of three techniques of tonsillectomy. EU Arch otorhinolaryngo. Sept 2011;10:405-11. DOI: https://doi.org/10.1007/s00405-020-06299-8
Tolska HK, Hamunen K, Takala A, Kontinen V. Systematic review of analgesics and dexamethasone for post-tonsillectomy pain in adults. British journal of anaesthesia. 2019 Aug 1;123(2):e397-411. DOI: https://doi.org/10.1016/j.bja.2019.04.063
Kaan MN, Odabasi O, Gezer E, Daldal A. The effect of preoperative dexamethasone on early oral intake, vomiting and pain after tonsillectomy. Int J Pediatre Otorhinolaryngol 2006;70(1):73-9. DOI: https://doi.org/10.1016/j.ijporl.2005.05.013
Akil A, Savitri E, Lokey HW. Comparison of Intraoperative Bleeding and Postoperative Pain of Tonsillectomy Using Method of Radiofrequency Dissection and Excision Dissection. Indian Journal of Public HealthResearch & Development 2019 Oct 1;10(10). DOI: https://doi.org/10.5958/0976-5506.2019.03042.0
Bhandari C, Sharma B, Pokharel A, Mayya NJ. Intraoperative Blood Loss, Surgical Duration and Postoperative Pain following Cold Dissection Tonsillectomy and Bipolar Electrocautery Tonsillectomy. Journal of College of Medical Sciences-Nepal 2021 Dec 31;17(4):341-6. DOI: https://doi.org/10.3126/jcmsn.v17i4.42212
Khan TH, Ibrahim M, Rana AH, Farooq M, Afzal M, Khosa SH. Comparison of Complications after Tonsillectomy between Conventional Cold Steel Dissections Method and Electrocautery Tonsillectomy Method. A Randomized Controlled Trial. Pakistan Journal of Medical & Health Sciences 2022 Nov 20;16(09):886-. DOI: https://doi.org/10.53350/pjmhs22169886
Chughtai A, Haq AU, Ullah S. Is the cold steel dissection method still the most effective method of tonsillectomy? Pakistan Armed Forces Medical Journal 2016 Oct 31;66(5):705-09. https://pafmj.org/PAFMJ/article/view/795
Nunez DA, Provan J, Crawford M. Post-operative tonsil ectomy pain in pediatric patients. Arch Otolaryngol Head Neck Surg 2000; 126(7):837-41. DOI: https://doi.org/10.1001/archotol.126.7.837
Robert F, Leinback, Stephen j, Markwell, Jerry A, Col liver et al. Hot versus cold tonsillectomy:a systemic review of literature. Otolaryngol Head Neck Surg 2003; 129(4):360-4. DOI: https://doi.org/10.1016/S0194-59980300729-0
Choudhary RK, Singh PK, Shrivastava N. A Comparison Between Dissection-Method and Diathermy Tonsillectomies in Rims, Ranchi. IOSR Journal of Dental and Medical Sciences 2017;16(1):45-7.
Gendy S, O'Leary M, Colreavy M, Rowley H, O'Dwyer T, Blayney A. Tonsillectomy-cold dissection vs. hot dissection: a prospective study. Ir Med J 2005;98(10): 243-4. https://europepmc.org/article/med/16445144 PMID: 16445144
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