Abstract
Purpose: To investigate whether children undergoing a tonsillectomy or adenotonsillectomy (AT) with Coblation® will experience less postoperative pain and return to a normal diet and a regular activity level sooner compared to the same procedure using electrocautery dissection. This may manifest less school and work missed by the child and caregiver, respectively. Materials and Methods: Seventy-four children between the ages 2-13 years with either obstructive sleep apnea or chronic tonsillitis were recruited at a single tertiary-care center from January 2011 to November 2012 and underwent an AT via electrocautery or Coblation®. Caregivers were given a ten-point Wong-Baker FACES pain scale and questions inquiring the degree of oral intake, activity level, and impact on both the child and caregiver in regards to missing work or school on postoperative days (POD) 0, 1, 2, 3, 5, 7, and 14. Results: Children in the Coblation® arm required less pain medications (p 0.0049) on POD 0. Subsequent results were not significantly different for any other day. Age- and gendered-controlled multivariate analysis revealed a statistically significant difference in pain medications administered (p 0.0001) but not pain scores (p 0.2115) between the two techniques, although this difference in medications is likely related to the results observed on POD 0. There was no incidence of postoperative hemorrhage in either group. Conclusions: While there was less pain medication administered and slightly improved oral intake of liquids on POD 0 for children in the Coblation® arm, there was no difference in subsequent postoperative outcome or hemorrhage rates.
Highlights
Adenotonsillectomies (AT) are regarded as one of the most common pediatric surgical procedures performed in the United States yearly, typically tasked to treat sleeprelated breathing disorders attributed to tonsillar and adenoid hypertrophy or to alleviate the impaired quality of life associated with recurrent tonsillitis
Children aged between 2 and 13 years undergoing tonsillectomy or AT for recurrent tonsillitis, sleep-disordered breathing, or obstructive sleep apnea were selected between January 2011 and November 2012 at a tertiary care hospital in a single blinded fashion to have the procedure performed via monopolar electrocautery or Coblation® (ArthoCare ENT)
52 Coblation® subjects and 22 electrocautery subjects returned with completed survey responses for a total study size of 74
Summary
Adenotonsillectomies (AT) are regarded as one of the most common pediatric surgical procedures performed in the United States yearly, typically tasked to treat sleeprelated breathing disorders attributed to tonsillar and adenoid hypertrophy or to alleviate the impaired quality of life associated with recurrent tonsillitis. Removing tonsillar tissue has conventionally been carried out using monopolar electrocautery, as its inherent superiority in hemostasis has helped it replace cold dissection techniques historically employed. There have been numerous documented accounts and anecdotal experiences of patient intolerance to postoperative pain, odynophagia, dysphagia, and subsequent dehydration with this surgical technique. This is not surprising considering the thermal damage subjected to adjacent tissues in light of local temperatures anywhere between 400 ̊C - 600 ̊C generated from direct contact between the electrode and the tissue [1]. First introduced as a viable surgical modality in 1998, another technique by which to perform AT utilizes plasma-mediated tissue ablation. Referred to as Coblation®, this process involves passing a bipolar radiofrequency current through isotonic saline to convert
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