Surgical technique may reduce pain after tonsillectomy

December 15, 2003

CHICAGO - Use of a surgical technique involving the microdissection needle -- an instrument that uses less energy than the standard approach electrocautery (which controls bleeding by heating tissues) - during surgical removal of the tonsils may reduce the amount of pain experienced after tonsillectomy, according to an article in the December issue of The Archives of Otolaryngology, one of the JAMA/Archives journals.

According to the article, despite the decline in the number of tonsillectomies performed in the past few decades, the procedure remains one of the most commonly performed surgeries. New technologies have evolved in surgery that shorten the surgery time, including the use of electrocautery (using a special scalpel that heats tissue as it cuts to seal wounds and prevent bleeding) also known as the "hot method". Pain after tonsillectomy is of special concern because it can interfere with eating and drinking, and researchers have observed an increase in pain associated with electrocautery.

Jonathan Perkins, D.O., of Childrens Hospital Regional Medical Center, Seattle, and Ravinder Dahiya, M.D., of Albany Medical Center, Albany, N.Y., investigated whether microdissection needle cautery (which is a type of electrocautery which uses less energy, and may therefore be less traumatic to tissues) reduced pain after surgery compared to standard electrocautery.

The researchers randomized 42 children to undergo tonsillectory into two groups: in group A, tonsillectomy was performed using standard electrocautery; in group B, tonsillectomy was performed using a lower-energy microdissection needle. The same surgeon performed all surgeries, which were identical except for the use of the instrument.

Patients were asked to rate their post-operative pain using a questionnaire based on a 10 point pain scale (10 being the worst pain). Doses of pain medication taken were also noted.

The researchers found that there was no difference in hemorrhage (bleeding) during the operations between the two groups. The operation took an average of 3.2 minutes longer for group B.

However, postoperative pain was less on days three, four and five following surgery for patients in the microdissection group than for patients in the standard electrocautery group.

"Without any increase in complications, subjective and objective measurement showed that the use of the microdissection needle resulted in significantly less postoperative pain by day three," the authors write.
-end-
(Arch Otolaryngol Head Neck Surg. 2003;129:1285-1288. Available post-embargo at archoto.com)
Editor's Note: The microdissection needle tips used in this study were provided by Colorado Biomedical Corporation, Evergreen, Colo.

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail mediarelations@jama-archives.org.

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