A prospective study to compare the effects of pre,intra and post operative steroid (dexamethasone sodium phosphate) on post tonsillectomy morbidity

Abstract

Objective:To determine the effectiveness of dexamethasone on post tonsillectomy morbidities in patients with chronic tonsillitis.Materials and Methods:In this randomized double-blind study, 100 patients who underwent tonsillectomy were enrolled and were randomly allocated into control or dexamethasone group (pre operative, intra operative and post operative groups). Patients were assessed for pain nausea, vomiting and oral intake in the post operative period at 24 h.Results:Patients treated with dexamethasone particularly in the pre and intra operative groups (Group B, Group C) showed a general trend towards lower pain score than post operative group (Group D). The scores were about 1.72±0.84 and 2.20±1.19 in Groups B and C respectively, and 2.64±0.99 in Group D. Overall pain score was found to be more in the control Group A about 4.84±1.21 at 6 h post operatively and showed similar trend for next 24 h. Total number of patients with nausea was significantly high about 84% in control group compared to dexamethasone groups (Group B, C and D) about 20%, 8% and 24% respectively and also incidence of vomiting episodes showed a similar trend. Oral intake was significantly delayed in control group (6.16 ±1.52), P < 0.001 than dexamethasone group. Pre operative and intra operative groups showed early intake (3.68±0.68) and (3.60±1.12) respectively than the postoperative group (5.08±0.95).Conclusions:A single intravenous dose of dexamethasone, given following induction of anaesthesia and at the time of surgery, provided prolonged analgesia, reduced nausea and vomiting and resulted in earlier oral intake.

Revisiting age‐related admission following tonsillectomy in the pediatric population

“…This was reflected in our study, as children demonstrated wide intake ranges as noted above, and were still offered discharge home without major complication. Analyzing oral intake in the postoperative setting across both age cohorts, no absolute value or interval change in oral intake reliably predicted the decision to discharge, continue observation, or offer interventions to patients in either the planned inpatient or expected outpatient cohorts, consistent with prior reports . Despite the growing body of evidence against utilizing adequate oral intake as a criterion for discharge, many would still be uncomfortable discharging a patient whose oral intake is modest or nil for fear of an adverse event.…”

Effects of oral prednisolone on recovery after tonsillectomy

“…Steroids inhibit the production of inflammatory cell factors such as cytokines in macrophages, monocytes, and lymphocytes and decrease extravasation of leucocytes, release of lysosomal enzymes, and vascular permeability in areas of injury leading to reduction in edema and fibrosis during healing. They also block the cyclooxygenase and lipoxygenase pathways by inhibiting phospholipase enzymes and relieve pain by reducing prostaglandin production . Together, these activities lessen the degree of inflammation and its accompanying signs and symptoms, and they are potentially beneficial for all forms of morbidity experienced by patients following tonsillectomy.…”

Systematic review of analgesics and dexamethasone for post-tonsillectomy pain in adults

“…28 Another study compared preoperative, intraoperative, and postoperative administration of the study medication with placebo. 42 There were 17 singledose and 12 multiple-dose studies. In studies that compared more than one analgesic with placebo, only one study arm was analysed.…”

“…26 We converted pain intensity values to a 0e10 scale when a 0e5 scale was used in a study. Pain intensity scales of 0e6 and 0e4 were used in one dexamethasone study 42 and in one gabapentin study, 44 respectively; in these studies, we considered that converting values to 0e10 scales would not be appropriate, and they were excluded from pain intensity comparisons in meta-analyses.…”

“…36,37,39,43 The total dose of rescue analgesic (combination of paracetamol 500 mg and codeine 16 mg) was reduced over 2e7 postoperative days in a study on dexamethasone for 8 postoperative days. 36 Pooled estimates demonstrated that dexamethasone was associated with less PONV during 24e48 h after operation (RR 0.41 [95% CI 0.29e0.59], P<0.001, I 2 ¼0%) 35,36,38,42 without increase in risk for PTH (RR 0.76 [95% CI 0.37e1.56], P¼0.46, I 2 ¼0%) 35,36,38,42 (four studies reported risk for PTH).…”