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Evidence summaries

Steroids for Improving Recovery Following Tonsillectomy in Children

A single dose of dexamethasone is effective in preventing post-operative vomiting for many children having their tonsils removed, without adverse effects. Level of evidence: "A"

A Cochrane review (abstract , review [Abstract]) included 19 studies with a total of 1 756 subjects. Children receiving a single intra-operative dose of dexamethasone (dose range 0.15 to 1.0 mg/kg) were half as likely to vomit in the first 24 hours than children receiving placebo (RR 0.49, 95% CI 0.41 to 0.58). Routine use in five children would be expected to result in one less patient experiencing post-tonsillectomy emesis (RD -0.24, 95% CI -0.32 to -0.15). Additionally, children receiving dexamethasone were more likely to advance to a soft/solid diet on post-tonsillectomy day 1 (RR 1.45, 95% CI 1.15 to 1.83) than those receiving placebo. Postoperative pain was improved in children receiving dexamethasone as measured by a visual analog scale (VAS 0 to 10) (MD -1.07, 95% CI -1.73 to -0.41), which correlates clinically to a reduction in pain (on a VAS of 0 to 10) from 4.72 to 3.65. No adverse events were noted in the included studies.

    References

    • Steward DL, Grisel J, Meinzen-Derr J. Steroids for improving recovery following tonsillectomy in children. Cochrane Database Syst Rev 2011;(8):CD003997. [PubMed]

Primary/Secondary Keywords