[Influence of intraoperatively applied current of coagulation on the postoperative course in tonsillectomy].
METHODS
Postoperative pain after tonsillectomy is greater using diathermy compared to the use of ligatures for hemostasis. In the present paper, the influence of coagulation current on the postoperative course is assessed quantitatively. The applied coagulation current was registered in Watt per second (Ws) in 63 patients. Intraoperative blood loss, operation time, experience of the surgeon, postoperative pain and the consumption of analgesics were registered.


RESULTS
The mean intraoperative blood loss was correlated to the amount of applied coagulation current. Operation time was reduced with increased coagulation current. The energy of the applied coagulation current correlated significantly with pain in the late postoperative period. There was no influence in the amount of coagulation current on the consumption of analgesics or postoperative hemorrhage. Blood loss was less and operation time was shorter with more experienced surgeons. Six secondary postoperative hemorrhages were observed. Hemorrhage occurred more often with inexperienced surgeons. The applied coagulation current was, however, not dependent on the surgeon's experience but on his individual technique for intraoperative control of hemostasis.


CONCLUSIONS
Pain following tonsillectomy is related to the amount of intraoperatively applied coagulation current, especially in the late postoperative course (days 10 - 14). This may be explained by tissue damage and increased eschar due to coagulation. Careful and reserved use of intraoperative coagulation will reduce postoperative pain.
Klinik für Hals-, Nasen- und Ohrenkrankheiten, Hals- und Gesichtschirurgie des Kantonspitals Liestal. Esther.Thomaser@ksli.ch
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D000234:Adenoids / Q000601:surgery; D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D014068:Tonsillectomy / Q000379:methods*