Purpose Scalpel handling is a hazard for surgical teams and patients. Electrocautery for skin incision, not only mitigates this risk, but may reduce operative time, intraoperative bleeding, and postoperative pain. Randomized control trials (RCT) have shown similar cosmetic outcomes but were limited to abdominal incisions. Hence a RCT was conducted on cosmetically sensitive cervicotomies for thyroid surgery in young adults. Here we report the secondary outcomes of this unique trial. Methodology This is a double-blinded, two arm RCT comparing scalpel and electrocautery incisions in patients less than 50 years old and requiring thyroid surgery. Primary outcome (not reported) was cosmetic outcome at 6 months. Secondary outcomes were postoperative pain (measured at 1 and 24 hours using the visual analogue scale (scored 1-10)) and in-hospital postoperative analgesia (measured in morphine milliequivalents). Results There were 96 patients. The two groups were similar in terms of age, sex, comorbidities, underlying pathology, and extent of surgery. Median post-operative pain at 1 hour was 5 (3-7) in scalpel and 4 (3-7) in the electrocautery groups (p=0.2). Median post-operative pain at 24 hours was 3 (2-5) in scalpel and 3 (1-4) electrocautery groups (p=0.1). The scalpel group required more morphine milliequivalents 24 (15-37), compared to the electrocautery group 20 (10-30), but the difference failed to reach statistical significance (p=0.08). Conclusion The use of the electrocautery to perform a cervicotomy is safer than using the scalpel and does not increase post-operative pain nor analgesia requirements.