Perioperative steroids in tonsillectomy using electrocautery and sharp dissection techniques

Objective: To determine the effect of preoperative dexamethasone sodium phosphate administration on post-tonsillectomy morbidity for electrocautery ("hot") and sharp ("cold") dissection techniques. Design: Prospective, randomized, double-blind study. Setting: University pediatric hospital and county teaching hospital. Subjects: A total of 219 children, aged 9 months to 12 years, undergoing tonsillectomy. Intervention: Participants who underwent tonsillectomy were randomly assigned to receive either intravenous dexamethasone sodium phosphate (1 mg/kg) or placebo. Outcome Measures: Pain scores, oral intake, and emesis on postoperative day (POD) 1. Results: A total of 106 subjects (62 undergoing hot and 44 cold tonsillectomies) received preoperative steroids, and 113 (56 hot and 57 cold tonsillectomies) received placebo. On POD 1, pain scores reported by patients (P = .02), parents (P = .002), and physicians (P<.001) were significantly lower in subjects receiving steroids than in those receiving placebo. Emesis was reduced from a mean of 2.1 (placebo group) to 1.2 episodes (steroid group) (P = .02). Oral intake improved from 24.5% of normal diet (placebo) to 31.7% (steroid group) (P = .004). When all 4 groups were compared (cold placebo, cold steroid, hot placebo, and hot steroid), pain scores reported by physicians and parents were significantly lower in the cold steroid group than in the other groups. Conclusions: Perioperative dexamethasone use reduces posttonsillectomy morbidity in pediatric patients in the early postoperative period after hot or cold tonsillectomy. The combination of steroid and cold dissection technique provided the greatest advantage in reducing posttonsillectomy subjective pain levels.