Evaluating the impact of surgical technique and corticosteroid use on post-tonsillectomy pain and bleeding

Tonsillectomy is one of the oldest and most common surgical procedures performed in otolaryngology. Various surgical techniques, including cold dissection and mixed techniques with steel instruments and electrocautery, have been explored to optimize patient outcomes, yet there is ongoing debate regarding their relative pros and cons. Additionally, corticosteroids are frequently administered perioperatively to mitigate pain and inflammation, although their efficacy in improving postoperative recovery remains a matter of debate. This prospective single-center observational study analyzed adolescents and adults undergoing elective tonsillectomy between September 2023 and December 2024, comparing cold dissection (n = 31) and mixed electrocautery (n = 15) techniques, with randomized administration of corticosteroids in nearly half the cohort (n = 20). Pain intensity, measured on a visual analog scale (VAS) for seven days postoperatively, showed a significant overall reduction in pain scores (p < 0.001) over time. However, no significant differences were found in pain levels or bleeding rates based on the surgical technique or corticosteroid use. Electrocautery demonstrated slightly lower initial pain levels but with no significant impact on overall pain trajectory or bleeding incidence. Overall, these findings suggest comparable outcomes in pain reduction and bleeding risk between the surgical techniques and corticosteroid administration, warranting further studies to explore potential benefits with larger sample sizes.