A randomized controlled trial for perioperative morbidity in microdebrider versus cold instrument dissection tonsillectomy

Abstract

Background: Tonsillectomy is a common procedure in children. It could produce moderate to severe post operative pain and morbidity. Preserving tonsillar capsule attached to pharyngeal constrictor muscle by microdebrider technique may reduce pain when compared to conventional cold dissection technique.

Objective: To compare the postoperative pain, perioperative, and postoperative morbidity between the microdebrider-assisted intracapsular tonsillectomy (MT) and cold instrument dissection tonsillectomy (CT).

Material and method: Forty children with ages between 3-14 years old in Songklanagarind Hospital with tonsillar hypertrophy were randomly assigned to have MT and CT in each group. Data of perioperative morbidity, time to start taking food, LOS, treatment satisfaction, post operative pain, and amount of analgesia were recorded for 7 days. Post operative complication was also followed-up.

Results: There were no statistical significantly differences between groups in operation time, time to start taking food, LOS, and amount of postoperative analgesia and treatment satisfaction score. The MT had significantly more blood loss during operation (54.3 +/- 35.45 mL) than the CT (14.78 +/- 18.71 mL) (p < 0.001). The MT had significantly less post operative pain score on postoperative day 2 (2.50 +/- 1.15 and 1.05 +/- 0.83) and 3 (1.70 +/- 0.80 and 1.05 +/- 0.76) (p < 0.05) but no difference on day 0, 1, 4, 5, 6. Pain score after analgesia was significantly better in the MT on day 0 (2.45 +/- 0.94 and 3.40 +/- 1.47) (p = 0.024) but no difference on day 1-6. There were no significant differences in fentanyl use for break through pain, immediate and delayed complications between the groups.

Conclusion: MT is an effective alternative procedure for children with tonsillar hypertrophy and results in improved postoperative pain but have more intraoperative blood loss.