Coblation vs electrocautery tonsillectomy: postoperative recovery in adults. Postoperative tonsillectomy pain in pediatric patients: electrocautery (hot) vs cold dissection and snare tonsillectomy--a randomized trial.
Comparison of coblation and monopolar electrocautery tonsillectomy in terms of postoperative pain and recovery.
                Prospective double-blind randomized controlled trial.
                Patients with recurrent tonsillitis requiring tonsillectomy were randomized to 2 groups: coblation or monopolar electrocautery tonsillectomy. Postoperative pain, complications, and days taken to return to work and normal diet were compared and analyzed with the aid of a pain diary, given to the patient.
                67 patients were recruited. Patients undergoing coblation tonsillectomy were able to return to normal diet in a shorter space of time following surgery. Patients undergoing coblation tonsillectomy were more likely to recommend the surgery than patients undergoing electrocautery tonsillectomy. No significant differences in the daily visual analog score for pain were seen for both groups of patients.
                Our results showed that coblation tonsillectomy has a faster recovery period and may offer advantages when compared to monopolar electrocautery tonsillectomy. To determine the effect of the method of tonsillectomy on postoperative pain in pediatric patients.
                Prospective, randomized, single-blind, controlled clinical trial.
                A university pediatric hospital in Aberdeen, Scotland.
                A volunteer sample of 54 children, aged 3 to 12 years, with recurrent tonsillitis or symptomatic adenotonsillar hypertrophy. Two patients withdrew consent.
                Twenty-six children underwent a nonelectrical (ie, cold) dissection tonsillectomy with cold steel instruments, 5 of whom also had adenoidectomy by curettage. Monopolar diathermy forceps were used for tonsillar bed hemostasis. Twenty-four children had electrocautery (ie, hot) dissection tonsillectomy, 7 of whom underwent adenoidectomy by curettage without a suction coagulator.
                Postoperative analgesic consumption, time to regain normal diet and activity levels, and complications.
                Patients who underwent hot dissection tonsillectomy showed no difference in time to first drink or analgesic use within the first 24 postoperative hours compared with children undergoing cold nonelectrical dissection tonsillectomy. The hot dissection tonsillectomy group took 7.5 (95% confidence interval [CI], 1-14.1) more doses of analgesics than the cold dissection group over the next 12 days (P<.05). The hot dissection tonsillectomy group took 2.5 more days than the cold dissection tonsillectomy group to regain normal diet (P<.05). Thirteen children (54%; 95% CI, 34-74) in the hot dissection tonsillectomy group and 6 (23%; 95% CI, 7-39) in the cold dissection tonsillectomy group sought outpatient care for throat pain, otalgia, poor diet, pyrexia, and/or bleeding (P<.05). Throat pain delayed in onset or of prolonged duration affected 9 children (38%; 95% CI, 19-57) in the hot dissection tonsillectomy group as opposed to 3 children (12%; 95% CI, 0-24) in the cold dissection tonsillectomy group (P<.05).
                Hot dissection tonsillectomy increases morbidity in pediatric patients in the recovery period following hospital discharge.
There are insufficient data to show that one method of tonsillectomy is superior. There is evidence that pain may be greater after monopolar dissection. Large, well designed randomised controlled trials are necessary to determine the optimum method for tonsillectomy.