A prospective randomized double-blind trial of fibrin glue for reducing pain and bleeding after tonsillectomy.
OBJECTIVE
Varying surgical techniques as well as a large selection of analgesics and other medications have been evaluated over the years in the hopes of reducing post-tonsillectomy pain. Several publications in recent years have demonstrated the efficacy of fibrin glue in reducing post-tonsillectomy bleeding and pain. The objectives of this study were to evaluate the effect of fibrin glue on pain and bleeding after tonsillectomy.


METHODS
A prospective randomized double-blind study was performed on 168 consecutive patients undergoing tonsillectomy for obstructive sleep apnea and chronic tonsillitis.


METHODS
Patients were randomly assigned to the treatment protocol. In the study group, the tonsillar beds were coated with fibrin glue (Quixil, OMRIX biopharmaceuticals) at the end of the operation. Patients in the controlled group underwent tonsillectomy without the use of fibrin glue. The patients were then monitored for postoperative bleeding, and a patient-based pain assessment instrument was used to evaluate pain, ability to eat and analgesics consumption for 10 days after surgery.


RESULTS
Ninety-six patients returned for postoperative follow up and filled in the questionnaire. As our medical center is the only hospital in the southern district of Israel and we hospitalize every person who presents with post-tonsillectomy bleeding, we can assume that any patient from either group who presented with post-tonsillectomy bleeding would be familiar to us. Analysis showed that no statistically significant differences relating to postoperative pain, bleeding, use of analgesics and postoperative eating resumption were detected between the patients treated with fibrin glue and controls.


CONCLUSIONS
We cannot substantiate a significant beneficial effect of fibrin glue in post-tonsillectomy pain control, prevention of bleeding or facilitating eating and thus find no indication for the routine use of fibrin glue in tonsillectomy.
Segal
Nili
N
Department of Otolaryngology-Head & Neck Surgery, Box 151, Soroka University Medical Center, Beer Sheva 84101, Israel. avichai@mcc.org.il
Puterman
Moshe
M
Rotem
Eran
E
Niv
Alexander
A
Kaplan
Daniel
D
Kraus
Mordechai
M
Brenner
Hilel
H
Nash
Michael
M
Tal
Asher
A
Leiberman
Alberto
A
D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010149:Postoperative Pain / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014068:Tonsillectomy
D015718:Fibrin Tissue Adhesive