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Pain scores and recovery post tonsillectomy: intracapsular versus extracapsular coblation

Published online by Cambridge University Press:  19 August 2019

M Junaid*
Affiliation:
Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
S Sood
Affiliation:
Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
H Walijee
Affiliation:
Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
J Dorgham
Affiliation:
Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
S De
Affiliation:
Department of Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
*
Author for correspondence: Mr Mustaffa Junaid, Department of Otolaryngology, Alder Hey Children's Hospital, East Prescot Road, Liverpool L14 5AB, UK E-mail: [email protected]

Abstract

Objective

This study compared post-tonsillectomy pain scores and recovery using the coblation-only technique, comparing extracapsular versus intracapsular approaches.

Methods

A prospective study was performed in our paediatric ENT department. Pain scores were recorded on days 0, 2, 4 and 8, using a visual analogue scale ranging from 0 (no pain) to 10 (extreme pain). Information was also collected on: return to normal fluid and solid intake, and any post-operative visits to primary care.

Results

In total, 101 patients were included in the analysis. Average pain scores were statistically lower on days 2, 4 and 8 in the intracapsular group compared to the extracapsular cohort. The intracapsular cohort also returned sooner to normal fluid and solids intake. The extracapsular group were more likely to visit the general practitioner post-operatively.

Conclusion

Intracapsular tonsillectomy appears to result in reduced morbidity overall and should be considered as a viable alternative in relevant cases.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited, 2019 

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Footnotes

Mr M Junaid takes responsibility for the integrity of the content of the paper

Presented orally at the British Association of Otorhinolaryngology – Head and Neck Surgery (BACO) International 2018 British Association for Paediatric Otolaryngology Symposium, 5 July 2018, Manchester, UK, and as a poster (awarded 1st prize) at the British Association for Paediatric Otolaryngology Annual Meeting, 14 September 2018, London, UK.

References

1Royal College of Surgeons. Commissioning Guide: Tonsillectomy. London: ENT UK, 2016Google Scholar
2Mahase, E. NHS England to save £200m on 17 ‘ineffective’ procedures including tonsillectomy. Pulse [online newspaper], 2 July 2018Google Scholar
3Kubba, H, Robb, P. About Children's Tonsil Surgery. London: ENT UK, 2015Google Scholar
4Lowe, D, van der Meulen, J, Cromwell, D, Lewsey, J, Copley, L, Browne, J et al. Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope 2007;117:717–24Google Scholar
5Woloszko, J, Stalder, KR, Brown, IG. Plasma characteristics of repetitively-pulsed electrical discharges in saline solutions used for surgical procedures. IEEE Trans Plasma Sci 2002;30:1376–83Google Scholar
6Pynnonen, M, Brinkmeier, JV, Thorne, MC, Chong, LY, Burton, MJ. Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev 2017;(8):CD004619Google Scholar
7Hoey, AW, Foden, NM, Hadjisymeou Andreou, S, Noonan, F, Chowdhury, AK, Greig, SR et al. Coblation® intracapsular tonsillectomy (tonsillotomy) in children: a prospective study of 500 consecutive cases with long-term follow-up. Clin Otolaryngol 2017;42:1211–17Google Scholar
8Breivik, H, Borchgrevink, PC, Allen, SM, Rosseland, LA, Romundstad, L, Breivik Hals, EK et al. Assessment of pain. Br J Anaesth 2008;101:1724Google Scholar
9Ferreira-Valente, MA, Pais-Ribeiro, JL, Jensen, MP. Validity of four pain intensity rating scales. Pain 2011;152:2399–404Google Scholar
10Lu, YX, Gu, QL, Wang, Z, Zhang, B, Liu, C, Liang, JQ. Pediatric coblation total tonsillectomy: intracapsular or extracapsular? Acta Otolaryngol 2017;137:1188–93Google Scholar
11Cohen, MS, Getz, AE, Isaacson, G, Gaughan, J, Szeremeta, W. Intracapsular vs. extracapsular tonsillectomy: a comparison of pain. Laryngoscope 2007;117:1855–8Google Scholar
12Byars, SG, Stearns, SC, Boomsma, JJ. Association of long-term risk of respiratory, allergic, and infectious diseases with removal of adenoids and tonsils in childhood. JAMA Otolaryngol Head Neck Surg 2018;144:594603Google Scholar
13Sumilo, D, Nichols, L, Ryan, R, Marshall, T. Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records. Br J Gen Pract 2019;69:e3341Google Scholar
14Lau, AS, Upile, NS, Wilkie, MD, Leong, SC, Swift, AC. The rising rate of admissions for tonsillitis and neck space abscesses in England, 1991-2011. Ann R Coll Surg Engl 2014;96:307–10Google Scholar