A randomised controlled trial to compare postoperative pain in children undergoing tonsillectomy using cold steel dissection with bipolar heamostasis <i>versus</i> coblation technique

Objective: To measure postoperative pain levels in children undergoing tonsillectomy, by two different techniques, cold steel dissection and coblator dissection. The hypothesis – that coblator dissection may be associated with less postoperative pain. Design: Prospective, randomised, double blind trial. Setting: Single centre, secondary care Children’s Hospital. Participants: Children aged between 4 and 16 years, undergoing tonsillectomy, or adeno-tonsillectomy. Exclusion criteria: children already taking regular analgesia and those who experienced postoperative bleeding. Seventynine children were recruited, nine were excluded. Main outcome measures: We compared analgesia requirements during the first 10 days, and also the return to normal eating and drinking. These were assessed, using a validated pain scale. All analgesic administration in hospital and at home was compared. The return to normal eating & drinking patterns, was also compared. Results: Whilst in the 24 h postoperatively there was no significant difference in the pain scores between the two groups, the coblator group required less potent analgesia. No statistical difference was identified between the two groups following discharge, except on the sixth postoperative day, when the coblator group had lower pain scores. This may represent chance, rather than a clear difference. Conclusion: The findings do not confirm the hypothesis that tonsillectomy undertaken in children, with the coblator device, is associated with lower levels of postoperative pain, but do indicate that less analgesia is required by the coblator patients in the first 12 h postoperatively