Abstract

Background and Aim: Morbidity related to postoperative nausea and vomiting, pain, poor oral intake, dehydration and fever is a concern in children undergoing tonsillectomy. The aim of this study was to investigate the effects of preoperative 0.5 mg/kg i.v. dexamethasone on postoperative quality oral intake, vomiting and pain in paediatric patients undergoing tonsillectomy with or without adenoidectomy, during the first 8 hours of the postoperative period. Material and Methods: This is a quasi-experimental study that was performed at the Ilam Imam Khomeini hospital, IR, during the year 2008-2009. In a randomized, double-blind trial, 66 paediatric patients undergoing tonsillectomy received IV placebo (saline) or 0.5mg/kg IV dexamethasone, after the induction of anaesthesia before surgery. The incidence of vomiting, the time to the first oral intake, the quality of oral intake and the pain score were compared in both groups during the first 8 hours of the postoperative period. Pain was assessed using a five-point "faces" scale (1 = smiling face: no pain, 5 = crying face: highest pain score). The quality of the oral intake was judged as follows: excellent = child requests it, good = child accepts it when offered, fair = child accepts it when coaxed, and poor = child refuses. All collected data were analyzed using the statistical software (SPSS, Ver.11.5), descriptive statistics, Student t test, Mann-Whitney test and the ×2 or Fisher's exact tests. p < 0.05 was considered significant. Results: The overall incidence of vomiting was significantly less in the Dexamethasone group as compared to the Saline group (p<0.001). The time of the first oral intake was shorter in the Dexamethasone group as compared to the Saline group (P<0.05). The quality of oral intake was better in the Dexamethasone group than in the Saline group (P<0.001). When compared with placebo, the patients who received preoperative dexamethasone had a significantly less pain score during the first 8 hours postoperatively (p < 0.05). Discussion and conclusion: In the paediatric patients undergoing tonsillectomy, preoperative dexamethasone use significantly reduced posttonsillectomy pain, improved oral intake and decreased vomiting without any significant side effects. This report confirms the beneficial effect of IV dexamethasone on postoperative morbidity related to vomiting, pain and oral intake in children after tonsillectomy and is recommended for routine use.