Do Steroids Reduce Morbidity of Tonsillectomy? Meta‐Analysis of Randomized Trials

Steward, David L.; Welge, Jeffrey A.; Myer, Charles M.

doi:10.1097/00005537-200110000-00008

Cited by 101 publications

(81 citation statements)

References 38 publications

(114 reference statements)

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“…5 Two metaanalyses demonstrated the benefits of a single dose of dexamethasone in controlling PONV following tonsillectomy. 6,7 Consequently, the American Academy of Otolaryngology-Head and Neck Surgery Clinical Practice Guideline on pediatric tonsillectomy provided a strong recommendation for the use of perioperative corticosteroid therapy. 8 A recent randomized trial studying the dose response of perioperative dexamethasone to PONV in children undergoing tonsillectomy was prematurely terminated due to an increased risk of postoperative hemorrhage.…”

mentioning

confidence: 99%

Perioperative Dexamethasone Administration and Risk of Bleeding Following Tonsillectomy in Children

Gallagher¹,

Hill²,

Ojha³

et al. 2012

JAMA

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mentioning

confidence: 99%

Perioperative Dexamethasone Administration and Risk of Bleeding Following Tonsillectomy in Children

Gallagher¹,

Hill²,

Ojha³

et al. 2012

JAMA

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“…Pain in the post-op is worse during the first five days, and although many treatment options have been studied, none was consistently successful [9][10][11][12][13][14] . In 2005, Collin et al 1 carried out a meta-analysis looking at randomized trials published in the literature and could not find statistically significant differences in post-op pain levels of adenotonsillectomy patients treated or not with antibiotics.…”

Section: Resultsmentioning

confidence: 99%

Avaliação da antibioticoterapia na morbidade pós-adenotonsilectomia: estudo prospectivo randomizado

Guerra

García

Pilan

et al. 2008

Rev. Bras. Otorrinolaringol.

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Tonsi llectomy with or without adenoidectomy still is one of the most commonly performed surgical procedures in the world, mostly in the pediatric population. Aim: to study the impact of amoxicillin for 7 days in post-adenotonsillectomy recovery, comparing results with a control group. Study type: prospective, randomized, controlled study with 120 patients. Patients and Methods: the patients were randomized according to surgery time to receive 7 days of amoxicillin associated with pain killers, or analgesic alone. During the first week of postoperative, we assessed the level of pain, oral intake acceptance, nausea and vomits, fever and return to daily activities. Results: It was only in the fourth postoperative day that the group receiving antibiotic agents showed a statistically significant difference as far as pain is concerned. There was no difference between the two groups for other data analyzed. Conclusion: considering the results from our study and reviewing the literature on the use of antibiotic agents, we agree that there is no improvement in patient recovery after adenotonsillectomy with the use of amoxicillin for 7 days in the postoperative.

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“…With increasing time after surgery the VAS scores difference between the two groups increased. Majority of dexamethasone treated patients were free from pain in 6-24h [10].…”

Section: Discussionmentioning

confidence: 95%

“…Steward et al [10] did a meta-analysis of randomized double blind placebo controlled trials of a single dose of intravenous intra-operative steroid for paediatric patients who underwent tonsillectomy or adenotonsillectomy. Eight trials met their inclusion criteria.…”

Section: Discussionmentioning

confidence: 99%

Effect of Dexamethasone for Reducing Post-Tonsillectomy Morbidity

Hiremath¹

2013

jemds

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BACKGROUND SURVEY: Vital healthcare resources are devoted to caring patients with prolonged hospitalization after routine, moderate risk surgery. Complications are assessed using a postoperative morbidity. Methods for reducing pain, nausea and vomiting after tonsillectomy are important to improve the standard of care our patients receive. OBJECTIVE: To determine the effects of a single dose of dexamethasone on post operative morbidity in patients undergoing tonsillectomy/adenotonsillectomy. DESIGN: It is a prospective double-blind randomized placebo controlled clinical investigation with ethical approval. METHODS: 60 patients (41 male and 19 female) aged between 4-15 years of ASA I-II undergoing tonsillectomy/adenotonsillectomy were the participants in this study. Patients were randomized to receive a single dose of IV dexamethasone or Placebo (saline). Post operative pain was assessed using either objective pain scale (OPS) or visual analogue scale (VAS). Anesthetic and surgical techniques were standardized. RESULTS: Statistically significant relative decrease in incidence of post operative pain, nausea and vomiting was seen in those treated with dexamethasone. Even statistically significant differences were seen in tolerance to oral fluids and discharge from the hospital between two groups. Tramadol 1 mg/kg n the first 6 hours and oral paracetamol 10ug/kg in the next 6-24 hours were administered. If OPS > 6 or VAS> 40 occurred. Incidence of nausea, vomiting and tonsillar bed oedema was noted. Pain scores were significantly less in dexamethasone group compared to control group. CONCLUSION: Dexamethasone given as a single dose of 0.15mg/kg at the time of induction of anesthesia is an effective safe and inexpensive method of reducing morbidity in tonsillectomy.

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Do Steroids Reduce Morbidity of Tonsillectomy? Meta‐Analysis of Randomized Trials

Abstract: Given the frequency of tonsillectomy, relative safety and low cost of dexamethasone, and the reduction in postoperative morbidity, we recommend routine use of a single intravenous dose during pediatric tonsillectomy.

Cited by 101 publications

References 38 publications

Perioperative Dexamethasone Administration and Risk of Bleeding Following Tonsillectomy in Children

Perioperative Dexamethasone Administration and Risk of Bleeding Following Tonsillectomy in Children

Avaliação da antibioticoterapia na morbidade pós-adenotonsilectomia: estudo prospectivo randomizado

Effect of Dexamethasone for Reducing Post-Tonsillectomy Morbidity

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