Change in mean postoperative pain in patients undergoing tonsillectomy with cold water versus usual practice: A pragmatic trial

• Published in: World journal of otorhinolaryngology - head and neck surgery 2024-03, Vol.10 (1), p.24-28
• Main Authors: Iftikhar, Haissan, Zahid, Nida, Zubair, Adan, Wasif, Mohammad, Baig, Nabeel N., Abid, Khadijah, Awan, Muhammad Ozair, Awan, Muhammad Sohail
• Format: Article
• Language: English
• Subjects: Age groups; cold water tonsillectomy; Cooling; Females; Gender; monopoalr tonsillectomy; Pain; Patients; Pediatrics; postoperative pain; Sleep apnea; Surgery; tonsillectomy; Tonsillitis; Water
• ISSN: 2095-8811; 2589-1081; 2589-1081
• DOI: 10.1002/wjo2.102

Introduction Tonsillectomy is one of the most common procedures performed in otolaryngology. There are various methods to perform tonsillectomies (cold and hot). Thermal damage and inflammation of the surrounding tissue using monopolar cautery is said to point to increased pain whereas immediate cooling of the burnt area is thought to reduce pain owing to heat dissipation. Our objective was to determine the difference in mean post‐tonsillectomy pain scores among patients irrigated with cold water (4°C) and in patients not irrigated with cold water. Material and Methods A quasi‐experimental trial was conducted from January 2016 to December 2017 at a tertiary care hospital. All tonsillectomies were carried out with monopolar cautery at a power of 20 W. Patients either received cold water irrigation post tonsillectomy of the tonsillar bed (intervention arm) or no irrigation (control arm). The pain score was measured on Days 0, 1, 3, 5, and 7. Pain scores were charted on a visual analog scale on the respective days. Results Seventy‐eight patients were included in the study. The mean age of our patients was 10.26 (4.24) years old in the intervention arm, and 11.95 (4.19) years old in the control arm. It was observed that the pain was significantly lower in patients with cold water irrigation of the tonsillar fossa on Days 1, 3, 5, and 7 (p = 0.001). There were no readmissions postprocedure and none of our patients developed any complications postsurgery. Conclusions In this trial, we report a reduced pain score at all days of observation in the intervention group. Irrigation of the tonsillar fossa is a safe, cost‐effective, and less technically demanding technique that could be employed to reduce postoperative pain. Further studies with randomization, blinding and a larger sample size could further improve on our results. Highlights Tonsillectomy is one of the most common procedures performed in otolaryngology. There are various methods to perform tonsillectomies (cold and hot). Thermal damage and inflammation of the surrounding tissue using monopolar cautery is said to point to increased pain whereas immediate cooling of the burnt area is thought to reduce pain owing to heat dissipation. Our objective was to determine a difference in mean posttonsillectomy pain score amongst patients irrigated with cold water (≤10°C) and in patients not irrigated with cold water. A pragmatic trial was conducted from January 2016 to December 2017 at a tertiary care hospital. Se