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Pain versus bleeding risk following tonsillectomy: do patients and doctors agree?

Published online by Cambridge University Press:  20 January 2009

T-H Low ,
P Harris ,
A Esterman  and
A S Carney
T-H Low
Affiliation:
ENT Unit, Department of Surgery, Flinders Medical Centre and Flinders University, Australia
P Harris
Affiliation:
ENT Unit, Department of Surgery, Flinders Medical Centre and Flinders University, Australia
A Esterman
Affiliation:
School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
A S Carney*
Affiliation:
ENT Unit, Department of Surgery, Flinders Medical Centre and Flinders University, Australia
*
Address for correspondence: A/Prof A Simon Carney, Associate Professor and Head of ENT Unit, Flinders Medical Centre, Bedford Park, SA 5042, Australia. Fax: +61 8 8219 9908 E-mail: simon@ent-surgery.com
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Abstract

Objective:

To investigate the differing opinions of patients and medical practitioners regarding the relative priorities of pain relief versus bleeding prevention following tonsillectomy.

Methods:

Questionnaires were mailed out to adult patients, paediatric patients' parents, general practitioners and ENT surgeons.

Results:

A total of 72/112 (64.3 per cent) questionnaires were returned. Adult patients, paediatric patients' parents, general practitioners and ENT surgeons all ranked bleeding as the most important factor when assessing risks related to tonsillectomy. Most adult patients indicated that they would accept a bleeding risk of 2 per cent; however, parents indicated that they would accept a higher bleeding risk (3 per cent) for their children in exchange for better pain control.

Conclusions:

Adult patients, paediatric patients' parents and doctors were slightly more inclined to ‘trade-off’ an increased post-tonsillectomy bleeding risk in exchange for better post-tonsillectomy pain control, although concerns about post-operative haemorrhage remained the main priority for all groups.

Keywords

TonsillectomyQuestionnairesPostoperative PainPost Operative Haemorrhage
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 9 , September 2009 , pp. 1015 - 1020
Copyright
Copyright © JLO (1984) Limited 2009

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References

1 Ramsden, R, Brown, P, Ryan, R, Yung, M, Browne, J, Copley, L et al. National Prospective Tonsillectomy Audit. London: British Association of Otolaryngology – Head & Neck Surgery and Royal College of Surgeons of England, 2005Google Scholar
2 Witsell, D, Orvidas, L, Stewart, M, Hannley, M, Weaver, E, Yueh, B et al. Quality of life after tonsillectomy in adults with recurrent or chronic tonsillitis. Otolaryngol Head Neck Surg 2008;138(suppl 1):1–8CrossRefGoogle ScholarPubMed
3 Schwentner, I, Schmutzhard, J, Schwentner, C, Abraham, I, Hofer, S, Sprinzl, G. The impact of adenotonsillectomy on children's quality of life. Clin Otolaryngol 2008;33:56–66CrossRefGoogle ScholarPubMed
4 Carney, A, Harris, P, MacFarlane, P, Nasser, S, Esterman, A. The coblation tonsillectomy learning curve. Otolaryngol Head Neck Surg 2008;138:149–52CrossRefGoogle ScholarPubMed
5 Polites, N, Joniau, S, Wabnitz, D, Fassina, R, Smythe, C, Varley, P et al. Postoperative pain following tonsillectomy: randomized clinical trial. A N Z J Surg 2006;76:226–9CrossRefGoogle ScholarPubMed
6 Stevens, M, Stenvens, D. Pain reduction by fibrin sealant in older children and adult tonsillectomy. Laryngoscope 2005;115:1093–6CrossRefGoogle ScholarPubMed
7 Cardozo, A, Hallikeri, C, Lawrence, H, Sankar, V, Hargreaves, S. Teenage and adult tonsillectomy: dose-response relationship between diathermy energy used and morbidity. Clin Otolaryngol 2007;32:366–71Google Scholar
8 Shapiro, N, Bhattacharyya, N. Cold dissection versus coblation-assisted adenotonsillectomy in children. Laryngoscope 2007;117:406–10Google Scholar
9 Timms, M, Temple, R. Coblation tonsillectomy: a double blind randomized controlled study. J Laryngol Otol 2002;116:450–2CrossRefGoogle ScholarPubMed
10 Burton, M, Doree, C. Coblation versus other surgical techniques for tonsillectomy. Cochrane Database Syst Rev 2007;CD004619CrossRefGoogle ScholarPubMed
11 McNeil, B, Weichselbaum, R, Pauker, S. Speech and survival: tradeoffs between quality and quantity of life in laryngeal cancer. N Engl J Med 1981;305:982–7CrossRefGoogle ScholarPubMed
12 Benzecri, J. Analyses des Donnees. Paris: Dunod, 1973:1, 2Google Scholar
13 Randall, D, Hoffer, M. Complications of tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg 1998;118:61–8CrossRefGoogle ScholarPubMed
14 Idvall, E, Bergqvist, A, Silverhjelm, J, Unosson, M. Perspectives of Swedish patients on postoperative pain management. Nursing & Health Sciences 2008;10:131–6Google Scholar
15 McClelland, L, Jones, N. Tonsillectomy: haemorrhaging ideas. J Laryngol Otol 2005;119:753–8CrossRefGoogle ScholarPubMed
16 Bennett, A, Clark, A, Bath, A, Montgomery, P. Meta-analysis of the timing of haemorrhage after tonsillectomy: an important factor in determining the safety of performing tonsillectomy as a day case procedure. Clin Otolaryngol 2005;30:418–23CrossRefGoogle ScholarPubMed
17 Ahsan, F, Rashid, H, Eng, C, Bennett, D, Ah-See, K. Is secondary haemorrhage after tonsillectomy in adults an infective condition? Objective measures of infection in a prospective cohort. Clin Otolaryngol 2007;32:24–7Google Scholar
18 O'Reilly, B, Black, S, Fernandes, J, Panesar, J. Is the routine use of antibiotics justified in adult tonsillectomy? J Laryngol Otol 2003;117:382–5Google Scholar
19 Yildirim, I, Okur, E, Ciragil, P, Aral, M, Kilic, M, Gul, M. Bacteraemia during tonsillectomy. J Laryngol Otol 2003;117:619–23Google Scholar
20 Dhiwakar, M, Eng, C, Selvaraj, S, McKerrow, W. Antibiotics to improve recovery following tonsillectomy: a systematic review. Otolaryngol Head Neck Surg 2006;134:357–64Google Scholar
21 Lavy, J. Post-tonsillectomy pain: the difference between younger and older patients. Int J Pediatr Otorhinolaryngol 1997;42:11–15CrossRefGoogle ScholarPubMed
22 Kelley, P. Painless tonsillectomy. Curr Opin Otolaryngol Head Neck Surg 2006;14:369–74Google Scholar
23 Pinder, D, Hilton, M. Dissection vs diathermy for tonsillectomy. Cochrane Database Syst Rev 2001;CD002211Google Scholar
24 Temple, R, Timms, M. Paediatric coblation tonsillectomy. Int J Pediatr Otorhinolaryngol 2001;61:195–8CrossRefGoogle ScholarPubMed
25 Stoker, K, Don, D, Kang, D, Haupert, M, Magit, A, Madgy, D. Pediatric total tonsillectomy using coblation compared to conventional electrosurgery: a prospective, controlled single-blind study. Otolaryngol Head Neck Surg 2004;130:666–75Google Scholar