Monopolar cautery versus cold steel dissection for tonsillectomy in children. a randomized clinical trial

Objective: To compare monopolar cautery with cold steel dissection for tonsillectomy in pediatric age group

Study Design: A randomized clinical trial

Place and Duration of Study: Ear, nose and throat [ENT] department Combined Military Hospital Gujranwala, from Jan 2013 to Jan 2015

Material and Methods: A total of 220 consecutive pediatric patients undergoing tonsillectomy for recurrent or chronic tonsillitis between Jan 2013 to Jan 2015. Both groups were compared with regards to surgery time, intraoperative bleeding, post operative pain and complications

Results: A total of 20 patients were excluded from the study for various reasons while the data of the rest of the patients has been presented. Mean age of the study group was 8.82 years. A total of 58% of the patients were male. Average time of surgery for monopolar cautery was 29.33 [SD 2.77] min as compared to 18.53 min [SD 2.94] for dissection method which was significant [p<0.005]. Average blood loss for monopolar surgery was 11.66 ml and 29.04ml for dissection method [p<0.005]. Average pain scores were less for dissection method at 2nd post op day 3.59 vs. 5.51. Rates of primary and secondary hemorrhage were less for monopolar method although they were not statistically significant

Conclusion: Monopolar cautery though causes decreased intraoperative blood loss however requires longer anesthesia and causes significant post operative pain to the patient

Comparison of complications of septal surgery with and without use of intra-nasal splints

To compare the adhesion formation and post-operative pain with and without intranasal splints in patients undergoing septal surgery with inferior turbinectomy. Comparative study. The study was carried out in CMH Rawalpindi from April2005 to Oct 2005. Total 60 patients undergoing septal surgery were randomly divided into two groups. In Group A intranasal splints [made from plastic infusion bottles] were placed with paraffin gauze packing and in Group B, paraffin gauze packing was done without intranasal splints. Follow-up was carried out at 48 hours and 01 week after surgery for assessment of pain scores, while adhesion formation was monitored for two months after surgery. Mean age of patients in Group A [with splints] was 26.43 years and of Group B [without splints] was 25.77 years. There was marked difference of pain scores at 48 hrs after surgery between two groups and difference was found highly significant [p value 0.001]. The p-value of pain score for data at one week was 0.022, still significantly different but lesser than the one at 48 hrs. Only two patients both without splints were found to have adhesions [p value 0.150]. It is concluded that intranasal splints increased post-operative pain significantly and there was no significant benefit in reducing the post-operative adhesion formation with splints