Post-operative pain following coblation or monopolar electrocautery tonsillectomy in children: a prospective, single-blinded, randomised comparison

Objective: To compare post-operative pain following tonsillectomy by either coblation or monopolar electrocautery in children. Design: A parallel-designed, prospective, single-blinded, randomised trial. Setting: Ambulatory surgical facility. Study participants: Eighty otherwise healthy paediatric patients undergoing coblation or electrocautery tonsillectomy by a fellowship-trained paediatric otolaryngologist. Main outcome measures: (i) The number of postoperative days with severe pain based on subjective qualification by the caretaker, (ii) post-operative days with pain rated 5 on a scale of 1-10, (iii) post-operative days requiring oral paracetamol/acetaminophen with codeine solution and (iv) post-operative days until resumption of a regular diet were assessed and recorded daily using a post-operative pain survey as a form of daily diary that was returned at the 2-week follow-up visit. Results: Patients were consecutively enrolled into two groups of 40 patients. Average ages were 5.2 years for coblation tonsillectomy and 6.0 years for electrocautery tonsillectomy. The average number of post-operative days with severe pain was 4.2 for coblation and 5.9 for electrocautery (P = 0.006), days rating pain 5 were 3.6 for coblation and 4.8 for electrocautery (P = 0.037), days of codeine use were 2.5 for coblation and 2.9 for electrocautery (P = 0.324), and days until resumption of a regular diet were 5.2 for coblation and 6.2 for electrocautery (0.329). Conclusions: Coblation tonsillectomy may reduce postoperative pain and the time until resumption of a regular diet compared to electrocautery tonsillectomy.