Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, South Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, South Korea.
Am J Otolaryngol. 2014 May-Jun;35(3):353-6. doi: 10.1016/j.amjoto.2014.01.005. Epub 2014 Jan 9.
Post-tonsillectomy pain is a notable concern and thermal injury produced by electric surgical devices is considered a main cause. Intraoperative cooling of the tonsillar fossa and pharyngeal mucosa with cold water has effectively reduced postoperative pain, but no studies have fully evaluated the effects of this technique with a proper study design. We assessed mucosal cooling in two groups of patients undergoing the same surgical technique by a single surgeon, with one group receiving cold-water cooling and the other group as a control.
Forty patients who underwent monopolar electrocautery tonsillectomy were randomly assigned to two groups (n = 20 for each group). Group 1 received cooling of the tonsillar fossa and pharyngeal mucosa with 4 °C saline just after removal of each tonsil whereas Group 2 did not receive cooling. Postoperative pain was recorded on operation day and 1, 2, 4, 7, and 10 days postoperatively. Post-tonsillectomy pain, return to normal diet, and incidence of postoperative bleeding were compared between the groups.
Post-tonsillectomy pain on 6 selected days and overall pain during the 10-day follow-up period were significantly lower in Group 1. However, return to normal diet and incidence of postoperative bleeding did not differ significantly between the groups.
Intraoperative application of cold water after tonsillectomy significantly reduced postoperative pain. We recommend cooling the tonsillar fossa and pharyngeal mucosa with cold water during tonsillectomy to easily and effectively reduce post-tonsillectomy pain.
扁桃体切除术后疼痛是一个值得关注的问题，电外科设备造成的热损伤被认为是主要原因。术中用冷水冷却扁桃体窝和咽黏膜可有效减轻术后疼痛，但尚无研究采用适当的研究设计充分评估该技术的效果。我们评估了由同一位外科医生采用相同手术技术的两组患者的黏膜冷却情况，一组接受冷水冷却，另一组为对照组。
40 例行单极电灼扁桃体切除术的患者被随机分为两组（每组 n = 20）。第 1 组在切除每侧扁桃体后立即用 4°C 生理盐水冷却扁桃体窝和咽黏膜，而第 2 组不接受冷却。术后当天以及术后 1、2、4、7 和 10 天记录术后疼痛。比较两组间术后疼痛、恢复正常饮食和术后出血的发生率。
第 1 组在 6 个选定的天数的扁桃体切除术后疼痛和整个 10 天随访期间的总体疼痛明显更低。然而，两组间恢复正常饮食和术后出血的发生率无显著差异。
扁桃体切除术后应用冷水可显著减轻术后疼痛。我们建议在扁桃体切除术中用冷水冷却扁桃体窝和咽黏膜，以简便有效地减轻扁桃体切除术后疼痛。
