title: Is the systemic inflammatory reaction to surgery responsible for post-operative pain after tonsillectomy, and is it "technique-related"?
abstract: OBJECTIVE
  Investigate the influence of operative technique on post-operative morbidity and the systemic inflammatory response after tonsillectomy. In addition, our aim was to compare the systemic inflammatory reaction, post-operative pain severity, and required time before the resumption of normal physical activity between two groups of tonsillectomized children and to correlate characteristics of the systemic inflammatory reaction to post-operative morbidity.
  
  
  METHODS
  This prospective, randomized, and single-blind study included 100 children between the ages of 3-16 years and who were scheduled for a tonsillectomy at our department for chronic tonsillitis and/or respiratory obstruction. The children were randomly assigned into one of two groups: either a conventional tonsillectomy with bipolar diathermy coagulation or a radiofrequency tonsillectomy procedure; both groups had a 14-day follow-up. We investigated the severity and duration of postoperative pain (based on the use of analgesics during the postoperative period), the postoperative day that they resumed normal physical activity, and the rate of postoperative hemorrhage. In order to assess the systemic inflammatory response, serum C-reactive protein (CRP) levels were measured before the surgery and seven days after the procedure.
  
  
  RESULTS
  After the surgery CRP levels increased to a statistically significant level (t = -4.7; p < 0.001) in conventional tonsillectomy group. There was a statistically significant correlation between increased blood CRP levels after the surgery and the level of post-operative analgesic consumption, which was based on an increased number of analgesic applications (r = 0.28; p < 0.01) and a greater number of days in which analgesics were consumed (r = 0.26; p < 0.01). There was also a correlation between increased blood CRP levels and a longer required time to resume normal physical activities (r = 0.30; p < 0.01).
  
  
  CONCLUSIONS
  Post-operative morbidity after tonsillectomy appears to depend on the systemic inflammatory response to surgery. This response is "technique-related," wherein a less-aggressive surgical technique produces a weaker post-operative inflammatory response and less post-operative morbidity.
authors: Department of ENT, Head and Neck Surgery, Split University Hospital, Split, Croatia. zroje@kbsplit.hr
authors: Zeljka
authors: Z
authors: Roje
authors: Goran
authors: G
authors: Racic
authors: Goran
authors: G
authors: Kardum
authors: Mirnes
authors: M
authors: Selimovic
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction / Q000601:surgery; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003289:Convalescence; D004564:Electrocoagulation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D016037:Single-Blind Method; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000209:etiology*; D014068:Tonsillectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D014069:Tonsillitis / Q000601:surgery
chemical_list: D002097:C-Reactive Protein