Release: Embargoed until September 24, 2000 Contact: Jennifer Felsher202-371-4517 (9/23-27)703-519-1549[email protected]
STUDY COMPARES TONSILLECTOMY PROCEDURES FOR PATIENT PAIN AND LENGTH OF RECOVERY
Research indicates that patients undergoing harmonic scalpel tonsillectomy return to regular diet and activity sooner than those who undergo electrocautery
Washington, DC -- Tonsillectomy is one of the most common surgical procedures performed on children. It can also be very painful. Therefore, any new technique that may alleviate the pain and subsequent recuperation period required for this surgery is of great interest.
Although the use of the harmonic scalpel is not new, its application to the removal of tonsillar tissue is. This study seeks to provide evidence that use of the harmonic scalpel provides optimum quality-of-life benefits to the patient and their families.
The authors of the study, "Harmonic Scalpel Tonsillectomy vs. Electrocautery Tonsillectomy," are Renee A. Walker, DO, of Joplin, MO, and Zubair A. Syed, MD of Chicago, IL. Dr. Walker will present the findings of the study on Wednesday, September 27, 2000, at the Annual Meeting/Oto Expo of the American Academy of Otolaryngology -- Head and Neck Surgery Foundation being held September 24-27, 2000, at the Washington, DC Convention Center.
Methodology: This preliminary, single blinded study was performed on a pediatric population in a large community referral center from April 1, 1999 to May 1, 2000. Three hundred and sixteen patients were randomized into two groups: those receiving the harmonic scalpel technique (HS) and those receiving the electrocautery technique (EC). These two main groups were then further divided by age: those children seven and younger and those eight and older.
Both study groups received similar perioperative and postoperative medications. All patients were injected with two cc of two percent lidocaine in the anterior and posterior pillars at the conclusion of surgery.
Patients less than three years old, or those who lived more than 30 minutes from the hospital, were admitted for an overnight stay. Every patient received a prescription for an antibiotic (amoxicillin or clindamycin) and acetaminophen with codeine for pain. No dietary restrictions were enforced on either group. In addition, the patients and/or parents were given a take-home questionnaire regarding the time required to return to normal diet and routine, the frequency with which pain medication was administered, estimated blood loss, and dehydration. A follow-up appointment was made for 10 --14 days postoperative.
Results: Electrocautery was used for 161 patients, while 155 patients underwent the harmonic scalpel technique. The average patient age was 7.1 years old.
Fifty four percent of the patients (or parents) responded to the questionnaire. Ninety-seven of these responses received the HS technique and 75 received the EC.
Forty-three (44.3 percent) of the HS patients returned to a regular diet 24 hours after surgery, while only 17 (22.7 percent) of the EC group did so. Seventy-two hours after surgery, the numbers are even more dramatic with 72 (74.2 percent) HS patients resuming a normal diet compared with only 35 (46.7 percent) HC patients. The results for return to normal activity were similar.
There was no significant difference in narcotic use for either group. Blood loss was minimal; the HS group experienced five late bleeds and the EC group nine.
Conclusions: This preliminary study supports the authors' assumption that harmonic scalpel tonsillectomies can provide a clear benefit to the pediatric patient. Post-operative recovery time, indicated by a return to diet and normal activity, is significantly less with the harmonic scalpel technique. Although there was no demonstrated difference in pain levels, when dealing with the pediatric population it is difficult to administer an accurate pain scale. Additional studies are needed to further evaluate this technique as standard of care for tonsillectomies.
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