Microdissection needle tonsillectomy and postoperative pain: a pilot study.
OBJECTIVE
To determine whether microdissection needle cautery for tonsillectomy results in decreased postoperative pain when compared with standard electrocautery.


METHODS
A randomized prospective study of 2 groups of young children in an academic pediatric otolaryngology practice.


METHODS
Forty-two healthy children between the ages of 4 and 12 years.


METHODS
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.


METHODS
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.
Perkins
Jonathan
J
Division of Pediatric Otolaryngology, Children's Hospital Regional Medical Center, MS 6E-1, 4800 Sand Point Way NE, PO Box 5371, Seattle, WA 98105-0371, USA. jonathan.perkins@seattlechildrens.org
Dahiya
Ravinder
R
D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004564:Electrocoagulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D042282:Microdissection / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008866:Microsurgery / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D009017:Morbidity; D009518:New York / Q000453:epidemiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D010865:Pilot Projects; D011187:Posture; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D014069:Tonsillitis / Q000601:surgery; D016896:Treatment Outcome
D000779:Anesthetics, Local; D002045:Bupivacaine