Microdissection needle tonsillectomy and postoperative pain: a pilot study.

Abstract

OBJECTIVE: To determine whether microdissection needle cautery for tonsillectomy results in decreased postoperative pain when compared with standard electrocautery. DESIGN AND SETTING: A randomized prospective study of 2 groups of young children in an academic pediatric otolaryngology practice. SUBJECTS: Forty-two healthy children between the ages of 4 and 12 years. INTERVENTION: The 42 children were randomly assigned to 2 groups: in group A, the tonsillectomy was performed with standard monopolar electrocautery tip at 20 W; in group B, the microdissection needle was used at 8 W. The same surgeon performed each tonsillectomy. Other aspects of the procedure were constant, including patient positioning, intraoperative injection of 0.25% bupivacaine hydrochoride (Marcaine), a weight-appropriate dose of steroids, and the use of postoperative antibiotics. OUTCOME MEASURES: The subjective measure of postoperative pain was a questionnaire based on a standard visual analog scale ranging from 0 to 10. More objective measures included the doses of pain medications consumed and the tolerance of oral intake. RESULTS: There was no statistical significant difference in the amount of intraoperative hemorrhage between groups (P>. 01). Operative time was on average 3.2 minutes longer in group B (11 minutes vs 7.8 minutes). The postoperative pain as measured by the visual analog scale was significantly different on days 3, 4, and 5 in group B (P<.05). This difference in pain correlated to differences in the number of doses of pain medications used on the same days. There was no statistically significant difference between the 2 groups concerning the amount of fluids tolerated (P>.01). CONCLUSIONS: 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 3.