Electrocautery versus epinephrine-injection tonsillectomy

This prospective, single-blinded study on tonsillectomy was done to compare the Bovie electrocautery dissection technique with the epinephrine-and-lidocaine injection technique and to document which technique is safer, faster, and less morbid. Twenty-nine patients who were scheduled for tonsillectomy at two Northern California Region Kaiser Permanente Medical Centers were enrolled in the study. Each patient served as his or her own control, and tonsillectomy technique was randomized on the basis of even or odd numbers of the last digit of the medical record number. The time of injection of epinephrine and time of dissection for each tonsil was recorded. Blood loss was quantified for each dissection, and pain was assessed by asking the patient which side hurt more. I found no statistically significant difference in operating time, intraoperative blood loss, or postoperative hemorrhage between these two methods. The electrocautery, or Bovie, technique produced more clinically significant eschar and delayed healing than the epinephrine-injection technique did. The Bovie technique produced more inadvertent burns to surrounding tissue than the epinephrine-injection technique did, but the epinephrine caused transient tachycardia in 14% of the study participants. The present study showed no difference between the two techniques in postoperative pain experienced by study participants, but other recent studies have shown that patients experience more pain when the Bovie technique is used. Study data do not support the superiority of Bovie tonsillectomy. I recommend epinephrine-injection tonsillectomy as a safe and expedient operation.