Coblation power settings and postoperative recovery in children with obstructive sleep apnea.

OBJECTIVE

To evaluate whether a modified lower Coblation power setting reduces postoperative pain and hemorrhage severity without compromising surgical efficacy in children undergoing adenotonsillectomy for OSA.

METHODS

In this single-blind, randomized clinical trial, 267 children with obstructive sleep apnea (OSA) were assigned to undergo surgery using either modified Coblation settings (level 5; n = 122) or traditional settings (level 7; n = 145). Outcomes included intraoperative blood loss, pain (FLACC-R/Wong-Baker FACES), pseudomembrane detachment time, OSA-18 scores, and post-tonsillectomy hemorrhage (PTH), which was graded by severity regardless of intervention, including mild cases such as blood-tinged saliva observed during pseudomembrane sloughing.

RESULTS

Modified Coblation settings significantly reduced intraoperative blood loss, postoperative pain, and eschar detachment time, while improving OSA-18 scores (all P < 0.001). Although overall PTH incidence was similar between groups, bleeding severity differed (P = 0.039): all PTH cases in the modified group were mild (Grade 1), while the traditional group had five severe cases (Grade 3) requiring surgical intervention. PTH onset also occurred earlier in the modified group (P = 0.004).

CONCLUSION

Low-energy Coblation settings can reduce postoperative pain and bleeding severity, possibly by shortening pseudomembrane detachment time and promoting faster healing. These findings support individualized adjustment of energy parameters to improve recovery quality and surgical safety in pediatric tonsillectomy.