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dissection in Tonsillectomy at Sawanpracharak Hospital

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Pimpet Sukumalpaiboon M.D.

Department of Otolaryngology

Swanpracharak Hospital

Nakhon Sawan

Sawanprachuak Medical Journal

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Abstract :

Objective To assess and compare the effectiveness of two different tonsillectomy

techniques: cold knife dissection and electrodissection; by comparingpostoperative morbidities.

Department of Otolaryngology, Sawanpracharak Hospital ffertiary care

hospital)

Prospective non-randomized controlled trial

Sixty tonsillectomy patients between September, 2006 and December,

2007 in Otolaryngology department, Sawanpracharak hospital.

Setting

Design

Subiects

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nEuurfi uurl:carr'fl atomt:ld eumaissection ril cold krife dissection

llnr:oir,i'anou6o1u'l:{rurrraar::ri:l:cmin#Prcspective Snrdy of Effetivenqs of Eleuodissetion ad Cold knife disstion

in Tonsillectomy at Sawanpracharak Hospiral 793

Method Sixty tonsillectomy patients were operated using either cold knife

dissection or electrocautery dissection. All patients received

dexamethasone intravenously during induction phase, antibiotic

prophylaxis and analgesic on regular basis. Patients were hospitalized

Ior 24-48 hours. The data collected include patient age, gender,

dexamethasone exact dose and method of operation. Post tonsillectomy

hemorrhage, severity of pain, incidence of nausea and vomiting, time

to first oral intake were assessed and recorded. Analysis of data was

done using SPSS. Outcome data were compared using unpaired t-test,

Mann Whitney test or Chi square analysis. A P-value < .05 was

considered statistically significant.

There were no statistically differences between the two techniques when

post-operative hemorrhage rate, severity of pain and evidence of emesis

are measured in the first post operative day. But in electrodissection

group, time to first oral intake is significantly lower than in cold

dissection group.

Tonsillectomy is by far one of the common otolaryngologic operations.

Morbidities include hemorrhage, pain, nausea and vomiting, delayed

postoperative oral intake. ln Sawanpracharak Hospital, there is evidence

that both tonsillectomy techniques are equally effective when

post-operative hemorrhage rate, severity of pain and evidence of

emesis are measured as outcomes.

Tonsillectomy, electrodiss@tion, cold knife dissection, dexamethasone,

morbidity

Results

Conclusion

Keywords

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uliuurfiuilJ:cAffinato,rnr:1{ Eecuodissection ril cold hife dissection

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electrodissection L[as cold knife dissection

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f a g :r ru a r n t :il r or z a.: yr&.: a o.,: n ri ruhi ur n n ri 1 {t du o e aa :

ou1{lJuEt6l1n6}!7r1\:dna (n1fl.111 2 tLas 3)

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t.

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fi arnr:or16flutaaav o.z rrn1rirrnndt:mr

afi fi :strcu?a1:?rJriauiurl:cilruoruT :da

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1 07!48.8 uT fi uliuu rfi uufl ufi n?1rJ un nri1.,lr ds o e aa )

ad'r.,:firia6irn'runT .,:afi fi e=0.006) (rt1fl{fi 5)

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9

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electrodissection (nrrhtii 4)

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u'rl]t3 1.0 ilnnn:ilnou1fiunn? 1 Rtnnril

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electrodissection ttuiasac 13.3 n1:a1r6uu un#aaav z.g'[u cold knife dissection aa],ir

{ I a & 1 ua dy b Jt?[3J{ 6t{ 24 t?LiJ{ 0Unn1:nizuilrafrtdvou?ntanuag Lunail cold knife dissectionq

v A ayI u5a B as Og.+ fi.,1 rir n'j'r nri ru electrodissection

Iy{u:afl ns 80.0 ou-anr:nifirhuiihi,hnq{

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uto cold knife dissection adr.:tnaeiromd.:

Hanasomo utarn6us('') lfiril5au rfi BU r{a?a{

nr:lfrfl r dexamethasone'[unr:air rr-or

electrodissection uns cold knife dissection

dexamethasone fi rua#n raudoalnl:ilrnuf.:il r rr-o un c nriu rJ :cr.r u a r r r :hi'j'r o c r{l u? 6

nr:ah oior uuu'ln Io a nr:td dexamethasone

iaruriu cold technique rir'lfraot morbiditiesJ'r- , v

il1 nTu In u railrcol n1:il? o ttarn1:iurj:cmtuarfir:

4 I % d,dafl1:Flfl l*1u?tluAUnn1:fuLr]il rAAnOAfl

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01fl{1U?OuU6lO'l1Anfl primary hemorrhage.lcrv a r u ad I a 9 o u d t v ttYl[t Tsgg[?d1[un1?t'l1nn uacao'n1:il:utilu iaaas 0 rirmiunt:alLduu nu'irridrunriru

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3.3 n6iil electrodissection finr:arr6auI

o ytt & r ,d d -tyAU1 9.111? UYhldA.: fl n il eJ1 tU?ElU tYl tlU nU Laf,{

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6.,J n'r 1 {.,1 a 1 e o fi u r u16'qr n il3ru r ruLrametna*n"#lfi ririliu:vrlrrrar:a ru riou

Iiuil:cfl r u ar mr:fi o rr:n fi nm ru un n sir.: fut dv o e aa f I0fl1{ilucl6{1nilm1\:dnn (P=0.006) tnunqru

etectrodisse.tiln fi:rs*rarradE 107148.8

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therapy dr et riu electrocaute rization de u 6a.,1

n r :iutj:smr u or r r :16vrt::r r r,, ard rir n,irA r tl C v d , C av A

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fi il:sf, nfi ar ahi uor n sir.: n-utu fir u? o{R.r? caurvdA

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d?il

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dAijpscnaruofis tzatge.o urfi uay rGuurfisu

riu rua nr:fi nu1fl fl { Hanasomo d.,:'[u rdar nr:iuil:smruarur:nu,irndru ebctrodissection

cold knife dissection 6.:ri.,:fr4#.:rnrt

flfl?au n ruq u1u rrv{Ylrirurlur

mandis1fl.:6' firnrirnriru.:rulam oa urRnqq

.e:-avdafuflrfuQn ailrf1EmTnil nfurnSrn mfll?d??:'AI o@ q

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n?1il??fl rfi a0 LmnlT?auu6tlrtaa?fl n

ronflrrdl{a{1. Younis RT, Lazer RH. History and current practice of tonsillectomy. Laryngoscope

2OO2; 112:3-5.

2. Weimert TA, Babyak JW, Richter HJ. Electrodissection tonsillectomy. Arch

Otolaryngology Head Neck Surg 1990; 116: 186-8.

3. Leinbach RF, Stephen J, Markwell MA, Colliver JA, Lin SY. Hot versus cold

thonsillectomy: a systemic review of literature. Otolarygology-Head and Neck

Surgery 2003; 129 (a): 360-4.

ujiolrfr ourj:vfrnrnaiornr:ld sbctodissedion til Cold knife dissection

1un r:irfi'nnoufi aluI:lnurrra ar:rdrj:alrinJPrmpective Study of Effwtivernss of El€trodissetion md Cold lnife disstim

in ToNillecDmy at Sawmpracharak Hospitaluil 5 quun 1 il.R.-ril.Er. 2551 799

4. Elhaki M, Ali NM, Rashed l, Riad MK, Refat M. Dexamethasone reduces postoperative

vomiting and pain after pediatric tonsillectomy. Canadian Journal of Anesthsia

2003; 50:392-7.

5. Steward DL, Welge JA, Myer CM. Do steroids reduce morbidity of tonsillectomy?

Meta-analysis of randomized trials. Laryngoscope 2001; 11'1: 1712-8.

6. Afman CE, Welge JA, Steward DL. Steroid for post-tonsillectomy pain reduction:

Metia-analysis of randomized controlled trials. CIolaryngology-Head and Neck Surgery

2006; 13a@):181-6.

7. Kim MS, Cote CJ, Cristoveanu D, Roth AG, Vornov P, Jennings MA, et al. There

is no dose-escalation response to dexamethasone (0.0625-1.0 mg/kg) in pediatric

tonsillectomy or adenotonsillectomy patients for preventing vomiting, reducing pain,

shortening time to first liquid intakes, or the incidence of voice change. Aneth Analg

2007;104: 1052-8.

8. Can MM, Williams JG, Carmicfrael L, NasserJG. Effect of steroids on posttonsillectomy

pain in adults. Arch Otolaryngol Head Neck Surg 1999; 125: 1361-4.

9. McKean S, Kochilas X, Kelleher R, Dockery M. Use of intravenous steroids at

induction of anaesthesia for adult tonsillectomy to reduce post-operative nausea and

vomiting and pain: a double-blind randomized controlled trial. Clinical Otolaryngology

2006; 31(1): 36-40.

10. Handler SD, Miller L, Richmond KH, Baranak CC. Post tonsillectomy hemorrhage:

incidence, prevention and management. Laryngoscope 1986; 96: 1243-7.

11. Kumar Fl. Secondary haemorrhage following tonsillectomy/adenoidectomy. J Laryngol

Otol. '1984; 98: 997-8.

12. Pinder D, Hilton M. Dissection versus diathermy for tonsillectomy: Cochrane database

of systemic reviews 2001, issue 4. [online] 2008 [cite 22 nY{.51]; Available from: URL:

http ://www. coch rane. o rol

13. Ranjit S, Brett RH, Lu PK, Aw CY. The irrcidence and management of post-tonsillectorny

haemorrhage: Singaporenan experience. Singapore Med J. 1999 Oct; 40(10):

622-6.

14. Hanasomo MM, Lalakea ML, Mikulec AA, Shepard KG, Wellis V, Messner AH.

Perioperative steroids in tonsillectomy using electrocautery and sharp dissection

techniques. Arch Otolaryngology Head Neck Surg 2OO4;130: 917-21.

800 fiuvftru: gXuralnqad 6?:T,i'1hfl1fnfirgar:

J v vi011T1{71 1 AnufusflA\:r,1il?El{

II OilA{

Cold knife

dissection(N=30)

Electrodissection

(N=30)P-value

L1i|FI (Z1EIn4fi.r1 OhUrU

arq 6J) median (range)

Dexamethasone dose (mg)

mearutSD

TvEtct?mr.i1n-n (mfi ) meantsDAdIAd,?[n1:uTctSJun?1il tquu? 6]

facial analog/verbal rating

scale (:1Er)

8122

13 (3-52)

6.6 + 3.1

37.0 + 16.4

8122

11119

20.5 (4.s-64)

8.0 + 2.8

32.3 + 10.3

6124

0.405

0.074

0.089

0.188

0.542

J - a d I v | 6l _ &t Y , &s- a cis9l'l:'l\:11 2 Tsnua?1ilLduu?oiln.railnnR1u-[u 0 {rlalturn uay rr.,:ttoi o .d'r[ru.ufi.,: e+ frh.,:

o falilrrrr:n (trt=got rlru.: (N=30)Cold knifedissection Electrodissection Coldknifedissection Elec.trodissection

o"rurulSoan;1,1'ruauliaanr; rirurulSaaar; siruru(5aEac)

:rnun?1il6l .

IAUU?FI

r-lrnvrulilXfi

ilanquu:.:

ilrprrutn

ilrnilrunar.,:,de

u?nranufl?r

lilil':or

1(3.3)

0

2(6.7)

11(36.7)

15(50.0)

1(3.3)

0

1(3.3)

4(13.4)

10(33.3)

14(46.6)

1(3.3)

0

0

1(3.3)

e(30.0)

1e(63.4)

1(3.3)

0

0

1(3.3)

4(13.4)

24(80.0)

1(3.3)

llvl 5 fluu7l 1 ri.a.-rli.u. 2551

nJEuurirouj:cffixatalnr:ld ehdodissecrioo riu cou knire dissecion

lunr:d rf,nyroufi nlul:lns rurnn::rrirlr;rrinfProspocive Sudy of Effectivems of Elecrodissectioo and Cold lnife dissection

in Toosilectomy 8t Sawmpracharak Hospiat 80 1

CIr1 :1,,:d g rGfl u rfi s u asuuu nm N r6u il ? oll a'r ajr n-odda.: m ar oir.: 1

dr{traril:crfiuns[uua']1ilr6Uilfn (mean rank)

Cold knife Electrodissection P-value*

dissection(N=30) (N=30)

VvtytvR1 EJfi a{nnUA1fl fi Oit r.l1 nA 28.62

32.15

32.98

32.13

32.90

32.43

31.05

32.38

28.85

28.O2

28.87

28.10

28.57

29.95

o.374

0.411

0.194

0.349

0.175

o.2M

0.794

&r v t u4 d2lil{fia{r.j1no&s u t u8 t?lil{ila{r.l1mo

&+12 {1lil,:ilA{Ai1n0t

1G d'rlru.:n#.rahd'Br&s v t v20 {?llhlilA{r.i10lA

24 drlru.:u#.,:r.irrirr

* Mann Whitney test

n1fl .,:d 4 :soiu Fr?1il?un:{?a.0R1?srf, onaanm Htu z+ d'rlur mfrrnhfin

:snun21ilTuttfi]q

a?JA{R1?vtnBAflAn

Cold knife dissection(N=30) Electrodissection (N=30)

ir'rurultaaavl o"rurultaaar;P-value

A tdAtililtaonoan

rdonilu . z n{ilnzrdaorrlu>en{.:/rr:JAailtaaFt

16aoranlmaaa fl naonr?a1

20(66.7)

8(26.71

2(6.6)

0

0

22(73.3)

8(26.7)

0

0

0

0.482

A J rrz d v I v o - &r I v011:1{n 5 O1n1:nnU[6[ E1t0gUfiA.:r.l1nn RlgtU 24 i?[U.: IAE:BgctlA1:2iln0il:U41fi1:

Avtun?{u1n fin{r.l1nn

{aN6$

Cold knife

dissection(N=30)

Electrodissection

(N=30)P-value

A ty c vnauLd a1u?u (iasas)

do-9alrasu a1u?u (iasac)

TsEtur?m3't ru ri aufurl:3mumfi 1:

1(3.3)

1(3.3)

128192.0

4(13.3)

2(6.7)

'107t48.8

0.161

0.554

0.006!dilau:n (urff) meaESD