Zusammenfassung
Hintergrund und Methode: In der vorliegenden Arbeit wird erstmals der Einfluss des intraoperativ angewandten bipolaren Koagulationsstromes auf den postoperativen Verlauf quantitativ untersucht. Es wurden bei 63 Patienten die applizierte Energiemenge des Koagulationsstromes gemessen, der Blutverlust, die Operationszeit, der postoperative Analgetikaverbrauch und die postoperativen Schmerzen mit einem Schmerzscore sowie die Nachblutungen und der Ausbildungsstand der Operateure erfasst und ausgewertet. Ergebnisse: Die Energiemenge des verwendeten Koagulationsstromes korrelierte mit dem mittleren intraoperativen Blutverlust bei den Kindern (p = 0,029) und den Erwachsenen (p = 0,038) sowie mit der subjektiv empfundenen Schmerzintensität in der späten postoperativen Phase. Der Erfahrungsstand der Operateure wirkte sich auf den intraoperativen Blutverlust, die Nachblutungsrate und die Operationszeit aus. Die Energiemenge des Koagulationsstromes war hingegen abhängig von der individuellen Operationstechnik. Schlussfolgerung: Die Menge des intraoperativ applizierten Koagulationsstromes wirkt sich signifikant auf die Schmerzen im späteren postoperativen Verlauf (10. - 14. Tag) aus. Dies kann durch eine verstärkte Gewebeschädigung durch die Diathermie erklärt werden. Eine sorgfältige, schonende Operationstechnik sowie ein sparsamer Umgang mit der Diathermie begrenzt somit die postoperativen Schmerzen.
Abstract
Background und Methods: Postoperative pain after tonsillectomy is greater using diathermy compared to the use of ligatures for hemostasis. In the present paper, the influence of coagulation current on the postoperative course is assessed quantitatively. The applied coagulation current was registered in Watt per second (Ws) in 63 patients. Intraoperative blood loss, operation time, experience of the surgeon, postoperative pain and the consumption of analgesics were registered. Results: The mean intraoperative blood loss was correlated to the amount of applied coagulation current. Operation time was reduced with increased coagulation current. The energy of the applied coagulation current correlated significantly with pain in the late postoperative period. There was no influence in the amount of coagulation current on the consumption of analgesics or postoperative hemorrhage. Blood loss was less and operation time was shorter with more experienced surgeons. Six secondary postoperative hemorrhages were observed. Hemorrhage occured more often with inexperienced surgeons. The applied coagulation current was, however, not dependent on the surgeon’s experience but on his individual technique for intraoperative control of hemostasis. Conclusions: Pain following tonsillectomy is related to the amount of intraoperatively applied coagulation current, especially in the late postoperative course (days 10 - 14). This may be explained by tissue damage and increased eschar due to coagulation. Careful and reserved use of intraoperative coagulation will reduce postoperative pain.
Schlüsselwörter
Tonsillektomie · Koagulationsstrom · Heilungsverlauf
Key words
Tonsillectomy · hemostasis · coagulation · postoperative pain
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Dr. Esther Genoveva Thomaser
Kantonsspital Liestal, Klinik für Hals-, Nasen- und Ohrenkrankheiten, Hals- und Gesichtschirurgie
Rheinstraße 26 · CH-4410 Liestal
eMail: Esther.Thomaser@ksli.ch
