A prospective randomised single blinded study comparing harmonic scalpel tonsillectomy with bipolar tonsillectomy.
OBJECTIVE
To compare the differences in pain, analgesic use and bleeding in children after tonsillectomy using either a harmonic scalpel or a bipolar diathermy surgical technique.


METHODS
Children 6-15 years presenting for tonsillectomy were randomised to either a harmonic scalpel or bipolar diathermy surgical technique. Post-operative pain scores (VAS, 0-10) were recorded within 30 min of surgery and again at the 4h hospital discharge. A subsequent telephone interview daily for 7 days and then every second day until day 13 was used to monitor pain scores, analgesic use and tonsil bed bleeding.


RESULTS
There were 204 children studied. The response rate over the first 7 days was 93% for the children in the harmonic scalpel group and 87% for the bipolar group. Children experienced moderate post-operative pain for the first 6 days, after which pain declined from 4-7 to reach a score of 1-2 by day 11. Children undergoing harmonic scalpel tonsillectomy (n=103) reported higher mean pain scores than those who underwent bipolar diathermy (n=101) for current pain (4.7 versus 4.2, p=0.002), worst pain of the day (6.9 versus 6.2, p<0.001) and pain on swallowing (5.9 versus 5.2, p<0.001) over the first 6 post-operative days. Analgesic use (acetaminophen, ibuprofen) was similar in both groups. Hospital readmission for bleeding in children who underwent harmonic scalpel was similar to those who underwent bipolar diathermy tonsillectomy (9% versus 11%) as was bleeding requiring surgical re-exploration (4% versus 2%).


CONCLUSIONS
Tonsillectomy was associated with considerable pain for the first 6 post-operative days. Children undergoing harmonic scalpel tonsillectomy had a slight increase in pain compared to the bipolar diathermy group during this time. Both methods of tonsillectomy are effective and safe.
Leaper
Matthew
M
Department of Paediatric Otolaryngology, Auckland Children's Hospital, Park Road, Auckland, New Zealand. mattkyla@xtra.co.nz
Mahadevan
Murali
M
Vokes
David
D
Sandow
Debby
D
Anderson
Brian J
BJ
West
Teena
T
D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use; D002648:Child; D004564:Electrocoagulation / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D010359:Patient Readmission / Q000706:statistics & numerical data; D019106:Postoperative Hemorrhage / Q000601:surgery; D011446:Prospective Studies; D016037:Single-Blind Method; D014068:Tonsillectomy / Q000295:instrumentation*; D016896:Treatment Outcome
D000700:Analgesics