Impact of Chilled Versus Room Temperature Saline on Procedure Time and Postoperative Outcomes Following Coblation Intracapsular Tonsillectomy and Adenoidectomy in Children With Sleep Disordered Breathing: A Randomised Control Trial

Background: Using chilled saline as a medium for Coblation has been shown to reduce post-operative pain in both paediatric and adult extracapsular tonsillectomy. Its effect on the more minimally invasive intracapsular tonsillectomy (ICT) is unknown. A double-blind randomised controlled trial was performed to identify the effect of chilled saline on operation length, intra-/postoperative bleeding, postoperative pain and return to normal activity in paediatric Coblation ICT with adenoidectomy. 

Methods: Forty-two paediatric patients undergoing Coblation ICT and adenoidectomy for sleep-disordered breathing were randomly assigned to receive either room temperature (22.5°C) or chilled saline (3.8°C) as the Coblation plasma medium. Duration of surgery, intra-/postoperative bleeding, postoperative pain (using the Wong–Baker Pain Scale) and return to normal activity were recorded. Both the surgeon and patients/parents were blinded to the procedure arm. 

Results: Results had a nonparametric distribution and were analysed using a Mann–Whitney U test. Chilled saline extended median total procedure time (17.5 vs. 15 min; p < 0.05) when compared to room temperature saline. There was no statistically significant difference in postoperative pain, nor was there a difference in secondary outcomes: intra-/postoperative bleeding and return to normal activity. 

Conclusion: The use of chilled saline for paediatric Coblation ICT carries no advantages in terms of postoperative pain or bleeding. Chilled saline actually extends procedure time when compared to room temperature saline. 

Trial Registration: Australian Clinical Trial Registry Number: ACTRN12624001267549.