Randomized controlled trial of coblation vs electrocautery tonsillectomy

Abstract

Objectives: To compare the postoperative recovery of patients receiving coblation-assisted intracapsular tonsillectomy to traditional electrocautery tonsillectomy. Methods: This was a prospective, randomized, double-blinded, controlled study. Eighty-three children, aged 2 to 17 years, were randomized to coblation or conventional electrocautery. Only patients with the operative indication of obstructive sleep apnea were entered into the study, and all received tonsillectomy and adenoidectomy by a single surgeon. Intracapsular tonsillectomy was performed on the coblation group, and traditional subcapsular dissection was performed on the electrocautery group. Adenoidectomy was performed with the curette in both groups. Outcomes measures were assessed on days 1, 3, and 5 following surgery. These included child and parental rating of pain using the Wong Faces pain scale, analgesic use, oral intake, activity level, and presence/absence of nausea and/or vomiting. Patients, parents, and the nurse practitioner obtaining the outcomes data were blinded to treatment. Results: Treatment groups were similar in age, gender, and weight. Surgical time was similar and estimated blood loss slightly less in the coblation group. There were no complications in either group. Coblation patients had less pain and greater oral intake at all 3 time points. Percent of normal activity level returned to above 70% earlier and more frequently in coblation patients. There was decreased analgesic use in the coblation group. After controlling for codeine or hydrocodone intake, there was no difference in nausea and/or vomiting. Conclusions: Children with obstructive sleep apnea undergoing tonsillectomy and adenoidectomy demonstrate significantly better postoperative recovery following coblation intracapsular tonsillectomy.