Tonsillectomy Surgical Procedures Compared for Post-operative Pain

The tonsillectomy, with or without adenoid removal, is a commonly performed operation. The surgical procedure is recommended for recurrent infected tonsils as well as enlarged tonsils, which can lead to pediatric sleep apnea and other breathing disorders. The pain can be severe, and patients are often unable to perform in work or school or eat regular food for a number of days after surgery.

The first reported tonsillectomy was performed by the Roman surgeon Celsus in 30 AD. He described scraping the tonsils and tearing them out or picking them up with a hook and excising them with a scalpel. Today, the scalpel or "cold steel" is still the preferred surgical instrument of many ear, nose, and throat specialists. In the 21st century, the surgeon now uses stainless steel scissors or a scalpel to remove the tonsil tissue from between two muscles in the back of the throat.

However, advances in technology have ushered in new instruments for use in this surgical procedure. In the United States, the most common instrument used for tonsillectomy currently is the electrocautery device. Two devices introduced more recently are the Harmonic Ultrasonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) and the Coblator® (ArthroCare Corp, Sunnyvale, CA); these instruments are now commonly used for tonsillectomy procedures.

Electrocautery burns the tonsillar tissue and assists in reducing blood loss through cauterization. Research has shown that the heat of electrocautery (400 degrees Celsius) results in thermal injury to surrounding tissue. This may result in more discomfort during the postoperative period. The Harmonic scalpel uses ultrasonic energy to vibrate its blade at 55,000 cycles per second. Invisible to the naked eye, the vibration transfers energy to the tissue, providing simultaneous cutting and coagulation. The temperature of the surrounding tissue reaches 80 degrees Celsius. Coblation, or radiofrequency ablation, works by passing a bipolar radiofrequency current through a medium of normal saline. This creates a plasma field of sodium ions. As the energy is transferred to the tissue, ionic dissociation occurs, which results in vaporization of tissue and coagulation of vessels at low temperatures (60°C).

Past research has revealed that post-operative pain rates for tonsillectomies using electrocautery, Harmonic Scalpel, and Coblation have been similar. A new research study, "Comparison of Post-tonsillectomy Pain Using the Ultrasonic Scalpel, Coblator, and Electrocautery," seeks to quantitatively measure the post-operative pain rates of the three surgical instruments. The authors of this research are Stephen P. Parsons MD, and Susan R. Cordes, MD and Brett Comer, from the Indiana University School of Medicine, Indianapolis, IN. This research article appears in the January, 2006, edition, Otolaryngology Head and Neck Surgery, the medical and scientific journal of the American Academy of Otolaryngology—Head and Neck Surgery.

Methodology: This prospective, randomized trial was conducted at Indiana University School of Medicine. All adult and pediatric patients undergoing tonsillectomy or adenotonsillectomy between December 2002 and December 2004 were invited to participate. One hundred thirty-four patients agreed to participate in the study. Sixty-one patients returned a completed diary. There were 43 patients in the electrocautery group, 44 patients in the Harmonic Scalpel group, and 47 patients in the Coblation group. The three groups did not differ statistically with regards to age, gender, indication for surgery, and return rate of the pain diary. Of the 134 patients, 127 underwent adenotonsillectomy and seven underwent tonsillectomy alone. Statistical analysis was performed on pain rating, food intake status, and activity level.