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

Redmann, Andrew J.; Maksimoski, Matthew; Brumbaugh, Cheryl; Ishman, Stacey L.

doi:10.1002/lary.27167

Cited by 18 publications

(14 citation statements)

References 21 publications

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“…They concluded that steroids should be used with caution as they may increase the severity of bleeding episodes. Notably, this meta-analysis was published prior to that of Redmann et al, 25 who recently published a retrospective review of 1200 patients, 900 of whom received postoperative steroids. They found an overall hemorrhage rate of 7%, with a significant 4% decrease in the steroid groups.…”

Section: Discussionmentioning

confidence: 99%

Hemorrhage Rates in Pediatric Patients Receiving Postoperative Steroids After Tonsillectomy

Noblitt

Siddiqui

Iverson

2020

Clin Pediatr (Phila)

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Importance. Developing a safe postoperative pain regimen after tonsillectomy is important. While postoperative steroids may provide an analgesic benefit, it is not known whether steroids increase the bleeding risk after tonsillectomy. Objective. To determine whether postoperative steroids increase the risk of hemorrhage after tonsillectomy in children. Design. Retrospective cohort study. Setting. Tertiary referral academic medical center. Participants. An age- and indication-matched cohort was randomly selected from tonsillectomy patients ≤12 years old from 2012 to 2017. Intervention. Prednisolone, 0.5 mg/kg (maximum dose 20 mg/day) qAM × 3 days postoperatively. Main Outcome. Postoperative hemorrhage requiring operative intervention. Results. A total of 1358 patients were included in this study, 679 of which received postoperative steroids. The steroid group had a similar of operative intervention for post-tonsillectomy hemorrhage of 1.8% versus 2.2% in the nonsteroid group ( P = .560). Conclusion and Relevance. Post-tonsillectomy steroid use is not associated with an increase in operative intervention for postoperative hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Hemorrhage Rates in Pediatric Patients Receiving Postoperative Steroids After Tonsillectomy

Noblitt

Siddiqui

Iverson

2020

Clin Pediatr (Phila)

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“…Since adoption of this standard at our institution, data supporting the efficacy of postoperative dexamethasone have led to inclusion of oral dexamethasone, though so far in a somewhat more limited capacity than that described by Redmann et al. 58 The rapidly evolving state of the art, as evidenced by the research highlighted in this review, call for periodic reassessment of practice patterns, and further adjustments will undoubtedly occur in the future.…”

Section: Our Approachmentioning

confidence: 93%

“…Positive clinical results from intravenous dexamethasone, combined with efforts to move away from opioids, has increased interest in a potential role for oral steroids in the postoperative period. A study by Redmann et al 58 examined the effect of adding dexamethasone (0.5 mg/kg, maximum dose 20 mg, every other day for 3 doses) to a regimen of scheduled acetaminophen and ibuprofen, along with rescue oxycodone for patients age 6 and over. They found a significant reduction in phone calls for pain and lower incidence of bleeding, and no incidents of steroid-related complications.…”

Section: Corticosteroidsmentioning

confidence: 99%

Pharmacologic management of post‐tonsillectomy pain in children

Jensen

2021

World j. otorhinolaryngol.-head neck surg.

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Tonsillectomy is a very common procedure in children, often performed on an outpatient basis. Severe postoperative pain is common, and can be prolonged. Despite a large number of available analgesic medications, often employed in combination, achieving adequate pain control remains a persistent challenge. Research suggests a tendency among caregivers to undertreat pain, and a need for detailed care instructions and education to ensure adequate pain management. Furthermore, ongoing questions regarding the safety and efficacy of the most commonly used medications have led to wide variance in practice patterns and continuous reassessment through research that yields sometimes conflicting results. This review summarizes the current state of the literature and presents a management approach which attempts to maximize pain control while minimizing potential harm with combinations of medications and modification based on patient-specific factors.

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“…170,171 They may also be utilized in sinonasal disorders and perioperative care. 172-175 Topical applications are frequently applied for adenoid, sleep, and sinonasal problems. 169,176-179 Some have considered holding SCSs during surgery for posttonsillectomy bleeding.…”

Section: Pediatric Considerationsmentioning

confidence: 99%

“…Corticosteroids are frequently indicated in children with airway compromise and laryngotracheal disorders 170,171 . They may also be utilized in sinonasal disorders and perioperative care 172‐175 . Topical applications are frequently applied for adenoid, sleep, and sinonasal problems 169,176‐179 .…”

Section: Pediatric Considerationsmentioning

confidence: 99%

Corticosteroid Use in Otolaryngology: Current Considerations During the COVID‐19 Era

Chang

McCoul

Briggs

et al. 2021

Otolaryngol.--head neck surg.

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Objective To offer pragmatic, evidence-informed advice on administering corticosteroids in otolaryngology during the coronavirus disease 2019 (COVID-19) pandemic, considering therapeutic efficacy, potential adverse effects, susceptibility to COVID-19, and potential effects on efficacy of vaccination against SARS-CoV-2, which causes COVID-19. Data Sources PubMed, Cochrane Library, EMBASE, CINAHL, and guideline databases. Review Methods Guideline search strategies, supplemented by database searches on sudden sensorineural hearing loss (SSNHL), idiopathic facial nerve paralysis (Bell’s palsy), sinonasal polyposis, laryngotracheal disorders, head and neck oncology, and pediatric otolaryngology, prioritizing systematic reviews, randomized controlled trials, and COVID-19–specific findings. Conclusions Systemic corticosteroids (SCSs) reduce long-term morbidity in individuals with SSNHL and Bell’s palsy, reduce acute laryngotracheal edema, and have benefit in perioperative management for some procedures. Topical or locally injected corticosteroids are preferable for most other otolaryngologic indications. SCSs have not shown long-term benefit for sinonasal disorders. SCSs are not a contraindication to vaccination with COVID-19 vaccines approved by the US Food and Drug Administration. The Centers for Disease Control and Prevention noted that these vaccines are safe for immunocompromised patients. Implications for Practice SCS use for SSNHL, Bell’s palsy, laryngotracheal edema, and perioperative care should follow prepandemic standards. Local or topical corticosteroids are preferable for most other otolaryngologic indications. Whether SCSs attenuate response to vaccination against COVID-19 or increase susceptibility to SARS-CoV-2 infection is unknown. Immunosuppression may lower vaccine efficacy, so immunocompromised patients should adhere to recommended infection control practices. COVID-19 vaccination with Pfizer-BioNTech, Moderna, or Johnson & Johnson vaccines is safe for immunocompromised patients.

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

Abstract: 4. Laryngoscope, 128:2187-2192, 2018.

Cited by 18 publications

References 21 publications

Hemorrhage Rates in Pediatric Patients Receiving Postoperative Steroids After Tonsillectomy

Hemorrhage Rates in Pediatric Patients Receiving Postoperative Steroids After Tonsillectomy

Pharmacologic management of post‐tonsillectomy pain in children

Corticosteroid Use in Otolaryngology: Current Considerations During the COVID‐19 Era

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