Evaluating postoperative pain in monopolar cautery versus harmonic scalpel tonsillectomy

OBJECTIVES: To compare postoperative pain between monopolar cautery tonsillectomy and harmonic scalpel tonsillectomy (HST). STUDY DESIGN: Randomized controlled trial using paired organs. SETTING: Community hospital with academic affiliation. SUBJECTS: One hundred and fourteen consecutive patients six years of age or older undergoing tonsillectomy for indications of hypertrophy or recurrent infection. METHODS: For each subject, monopolar cautery tonsillectomy was performed by four senior surgeons on one side and HST was performed on the other side. Allocation of technique to side was randomized and revealed to the surgeon at the start of the operation. Validated visual analog pain scales were used to quantify pain at rest and with swallowing for each side and were completed daily for 14 days. All subjects were prescribed weight-equivalent doses of analgesics. Secondary outcome measures included postoperative complications (hemorrhage and readmission). RESULTS: Pairwise comparisons of pain scores revealed no significant difference between monopolar cautery tonsillectomy and HST (P < 0.05). CONCLUSIONS: Subjects undergoing monopolar cautery tonsillectomy do not experience increased postoperative pain in comparison to HST. (C) 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.