Objective: To compare post operative pain and hemorrhage in children after tonsillectomy with bipolar
diathermy versus tonsillectomy with cold steel dissection and silk ligation to secure hemostasis.
Study Design: Randomized controlled trial.
Place and Duration of Study: Combined Military Hospital (CMH) Kharian from June 2012 to June 2013.
Materias and Methods: A total of 126 patients were included in the study through non-probability
convenience sampling and randomly divided in two groups of 63 each. In group A patients were treated by
tonsillectomy with bipolar diathermy and in group B patients underwent tonsillectomy with cold steel
dissection and silk ligation to secure hemostasis. Results in terms of postoperative hemorrhage and pain
based on Facial Pain Scale were observed.
Results: A total of 126 patients were included in the study and randomly divided in two groups of 63 each.
Average age in group A was 6.60 years (SD ± 2.46) and in group B it was 6.31 years (SD ± 2.48). There were 33
males (52.38%) in group A while 37 males (58.73%) in group B. Both the groups are comparable with respect
to gender (p=0.473) and age (p=0.522). In group A, there were 5 (7.93%) cases of mild pain as compared to 15
(23.80%) in group B. Similarly there were 32 (50.79%) cases of moderate pain in group A and 39 (61.90%) in
group B. In group A 25 (39.68%) had severe pain as compared to 9 (14.28%) in group B. It indicates that
patients who underwent tonsillectomy with bipolar diathermy had significantly high frequency of severe pain
than group A (p=0.03). In both groups there was no incidence of primary hemorrhage. In group A, 3 (4.76%)
patients had secondary hemorrhage and in group B, 1 (1.58%) patient had secondary hemorrhage however
this was insignificant (p = 0.310).
Conclusion: Cold steel tonsillectomy technique with silk ligation to secure hemostasis is a safe method. It has
significantly less postoperative pain as compared to bipolar diathermy technique. However there is no
significant difference in post operative hemorrhage between the two methods.
Bipolar diathermy, Cold steel Dissection, Tonsillectomy.