Lin Chen, Thung Arlyne K, Jatana Kris R, Cooper Jennifer N, Barron L Christine, Elmaraghy Charles A
Department of Otolaryngology-Head and Neck Surgery Nationwide Children's Hospital and The Ohio State University Wexner Medical Center Columbus Ohio.
Department of Anesthesiology and Pain Medicine Nationwide Children's Hospital Columbus Ohio.
Laryngoscope Investig Otolaryngol. 2018 Nov 28;4(1):154-159. doi: 10.1002/lio2.212. eCollection 2019 Feb.
Based on previous studies in the pediatric population, it remains unclear whether there is a difference in postoperative pain between two widely used tonsillectomy techniques: coblation and bovie electrocautery. This large prospective study investigates whether postoperative pain scores differ between these two surgical techniques for tonsillectomy.
Prospective, non-randomized study of children aged 2-8 enrolled in a randomized controlled trial of single-dose intravenous acetaminophen for pain associated with adenotonsillectomy. Included procedures occurred between October 2012 and June 2015 at a tertiary referral center. Only patients whose operations exclusively used coblation or electrocautery and who required postoperative admission for extended observation were included. Follow-up period was the length of inpatient stay. Patients and nurses who recorded the pain scores were blinded to the tonsillectomy technique.
A total of 183 patients were included: 117 coblation cases and 66 electrocautery cases. Pain scores in the surgical recovery unit and pain scores after admission to the floor unit were not significantly different between coblation and electrocautery, either before or after adjustment for patient age, body mass index, intravenous acetaminophen use, and surgeon. There was also no difference in length of stay, readmission rate, or post-tonsillectomy hemorrhage.
Coblation and electrocautery tonsillectomy are associated with similar post-operative pain scores in the recovery and inpatient units in the pediatric population. As coblation is costlier, the results of this study may affect which tool is used by otolaryngologists from a cost-benefit perspective.
III.
基于此前针对儿科人群的研究，两种广泛应用的扁桃体切除术技术——低温等离子射频消融术和电刀切除术——术后疼痛是否存在差异仍不明确。这项大型前瞻性研究调查了这两种扁桃体切除手术技术的术后疼痛评分是否存在差异。
对年龄在2至8岁、参加了单剂量静脉注射对乙酰氨基酚治疗腺样体扁桃体切除术后疼痛的随机对照试验的儿童进行前瞻性、非随机研究。纳入的手术于2012年10月至2015年6月在一家三级转诊中心进行。仅纳入手术仅采用低温等离子射频消融术或电刀切除术且术后需要住院进行延长观察的患者。随访期为住院时间长度。记录疼痛评分的患者和护士对扁桃体切除技术不知情。
共纳入183例患者：117例低温等离子射频消融术病例和66例电刀切除术病例。在对患者年龄、体重指数、静脉注射对乙酰氨基酚的使用情况和外科医生进行调整前后，低温等离子射频消融术组和电刀切除术组在手术恢复单元的疼痛评分以及进入病房单元后的疼痛评分均无显著差异。住院时间、再入院率或扁桃体切除术后出血情况也无差异。
在儿科人群的恢复单元和住院单元中，低温等离子射频消融术和电刀切除术扁桃体切除术后疼痛评分相似。由于低温等离子射频消融术成本更高，本研究结果可能会从成本效益角度影响耳鼻喉科医生使用哪种工具。
III级
