Post-tonsillectomy pain and vomiting:role of pre-operative steroids.

OBJECTIVE To evaluate the effects of a single pre-operative dose of dexamethasone with the frequency of postoperative vomiting and severity of throat pain in children undergoing electrocautery tonsillectomy under standard general anaesthesia. STUDY DESIGN Randomised controlled trial. PLACE AND DURATION OF STUDY ENT Department, Combined Military Hospital, Kharian, from January to December 2010. METHODOLOGY Children of either gender aged between 4 - 12 years, undergoing tonsillectomy were divided into two groups of 50 each. One group was selected to receive dexamethasone 0.5 mg/kg (maximum of 8 mg); the second group was given equivalent volume of saline, pre-operatively. The frequency of early and late vomiting was assessed postextubation. Mean time of first oral intake in minutes after extubation and mean score of postoperative throat pain were compared in both groups. Severity of throat pain was monitored by Visual Analogue Scale (VAS) score 0-10 after 4,8,12 and 24 hours of extubation. RESULTS Dexamethasone group showed significantly less postoperative early vomiting (12%, n = 6) as compared to placebo (30%, n = 15) group (p < 0.05). The mean time of first oral intake was earlier in the dexamethasone group (4 hours and 16 minutes postextubation), while in saline group it was 5 hours and 20 minutes (p < 0.001). Pain score was also significantly lower and swallowing was less painful in patients after 4,8,12 and 24 hours in dexamethasone group. Pain score on the average was 0.8 - 1.2 factors less in dexamethasone group than in saline group in first 24 hours on a VAS score of 1 -10. CONCLUSION Pre-operative intravenous dexamethasone reduced postoperative vomiting and pain significantly in children undergoing electrocautery tonsillectomy.