COMPARISON OF POSTOPERATIVE PAIN AND HEMORRHAGE IN CHILDREN AFTER TONSILLECTOMY WITH BIPOLAR DIATHERMY TECHNIQUE VERSUS TONSILLECTOMY WITH COLD STEEL DISSECTION AND SILK LIGATURE

Pain and Hemorrhage in Children after Tonsillectomy

Abstract

Objective: To compare post operative pain and hemorrhage in children after tonsillectomy with bipolar diathermy versus tonsillectomy with cold steel dissection and silk ligation to secure hemostasis.

Study Design: Randomized controlled trial.

Place and Duration of Study: Combined Military Hospital (CMH) Kharian from June 2012 to June 2013.

Materias and Methods: A total of 126 patients were included in the study through non-probability convenience sampling and randomly divided in two groups of 63 each.  In group A patients were treated by tonsillectomy with bipolar diathermy and in group B patients underwent tonsillectomy with cold steel dissection and silk ligation to secure hemostasis. Results in terms of postoperative hemorrhage and pain based on Facial Pain Scale were observed.

Results: A total of 126 patients were included in the study and randomly divided in two groups of 63 each. Average age in group A was 6.60 years (SD ± 2.46) and in group B it was 6.31 years (SD ± 2.48). There were 33 males (52.38%) in group A while 37 males (58.73%) in group B. Both the groups are comparable with respect to gender (p=0.473) and age (p=0.522). In group A, there were 5 (7.93%) cases of mild pain as compared to 15 (23.80%) in group B. Similarly there were 32 (50.79%) cases of moderate pain in group A and 39 (61.90%) in group B. In group A 25 (39.68%) had severe pain as compared to 9 (14.28%) in group B. It indicates that patients who underwent tonsillectomy with bipolar diathermy had significantly high frequency of severe pain than group A (p=0.03). In both groups there was no incidence of primary hemorrhage. In group A, 3 (4.76%) patients had secondary hemorrhage and in group B, 1 (1.58%) patient had secondary hemorrhage however this was insignificant (p = 0.310).

Conclusion: Cold steel tonsillectomy technique with silk ligation to secure hemostasis is a safe method. It has significantly less postoperative pain as compared to bipolar diathermy technique. However there is no significant difference in post operative hemorrhage between the two methods.