The Effect of a Postoperative Course of Oral Prednisone on Postoperative Morbidity following Childhood Tonsillectomy

Abstract

There is no evidence of benefit from postoperative administration of corticosteroids in pediatric patients recovering from tonsillectomy.

A survey of the administration of prednisolone versus ibuprofen analgesic protocols after ambulatory tonsillectomy

“…Prednisolone was replaced by ibuprofen in the second part of the study. One reason was the weak impact of prednisolone on pain scores and PONV after tonsillectomy [4,5]. Indeed, one study found comparable pain scores between placebo and prednisolone administered during 7 days after tonsillectomy, with only a reduction in nausea after POD4 [4].…”

“…Indeed, one study found comparable pain scores between placebo and prednisolone administered during 7 days after tonsillectomy, with only a reduction in nausea after POD4 [4]. Recently, a placebo-controlled study did not evidence any difference in pain scores, feeding and PONV after tonsillectomy in children [5]. Methylprednisolone at 2.5 mg/kg appeared to be non-inferior to dexamethasone at 0.5 mg/kg in a prospective study with PONV prevention as the primary outcome, with a difference of 8% [95% CI; -5% to 21%] [20].…”

“…There is a concern about the risk of bleeding in patients receiving NSAIDs before and/or after tonsillectomy [5,9,10,24,26]. In a meta-analysis including 505 patients, Marret et al found a 3.8 fold-increased risk of bleeding with NSAIDs [7]; four of the seven studies included used ketorolac.…”

Comment substituer la codéine après amygdalectomie chez l’enfant de moins de 12ans ? Recommandation de la Société française d’oto-rhino-laryngologie et de chirurgie de la face et du cou

“…Palme compare dans une étude de faible puissance, la prednisolone à un placebo administrés pendant 7 jours après amygdalectomie ; il retrouve un effet limité de la prednisolone sur les nausées, vomissements et les scores de douleur (versus placebo) [35] (niveau de preuve 2). En 2012, Macassey montre que, comparée à un placebo, l'utilisation de prednisolone en adjonction d'un traitement antalgique standard (paracétamol, codéine, ibuprofène) ne modifie pas le profil de douleur ou de vomissements chez des enfants après amygdalectomie [36] (niveau de preuve 2).…”

The effect of postoperative steroids on post‐tonsillectomy pain and need for postoperative physician contact

“…They based these recommendations on randomized studies showing that systemic formulations of steroids have been proven to reduce pain, decrease time to oral liquid ingestion, and decrease nausea . Given the effectiveness of perioperative dosing, a course of postoperative steroids has been shown in at least two studies to be a means to improve post‐tonsillectomy outcomes, whereas another study has reported no significant improvement in postoperative outcomes with steroid use . Given the conflicting nature of previous reports, we sought to examine the effect of a postoperative steroid course on post‐tonsillectomy outcomes, with a specific focus on returns to the ED for pain or bleeding, post‐tonsillectomy hemorrhage rates in the first 30 days after surgery, and phone calls to the otolaryngologists office representing an unplanned physician contact.…”