Background: There are multiple techniques used for tonsillectomy including monopolar cautery. Monopolar electrocautery creates an electrical arch that occurs between the tissue and the appliance, which cause thermal damage with subsequent post-operative discomfort. It is hypothesized that normal saline injection may reduce thermal damage during monopolar cautery.
Aim of the work: To evaluate the role of intraoperative use of hypertonic saline in tonsillar fossa for reduction of patients' pain and discomfort.    
Patients and Methods: This study included 50 pediatric patients indicated for tonsillectomy. Patients were divided into 2 groups; group [A]: 25 patients have electrical mono polar tonsillectomy with hypertonic saline injection into peritonsillar fossa, and group [B]: 25 patients have electrical mono polar tonsillectomy without hypertonic saline injection. The main outcomes were intraoperative blood loss, surgery duration and postoperative pain.
Results: In our study, patients in group [A] had significant reduction of blood loss [P=<0.001]. Regarding pain scores, patients in group [A] showed significant decrease of VAS started 2 hours after surgery, and continued for the first 24 hours [p-value < 0.001].
Conclusion: Hypertonic saline injection significantly associated with less blood loss, decreased post-operative pain and need for analgesia. Further large-scale studies are recommended.