Abstract
A combination of dexamethasone, ondansetron, and total intravenous anaesthesia (TIVA) is recommended as prophylaxis to prevent postoperative vomiting (POV) in high-risk children. Implementing TIVA in paediatric anaesthesia presents challenges due to its widespread ease of use. Regarding lidocaine’s antiemetic effect in paediatric patients, incorporating lidocaine can mitigate POV in high-risk children. Among 204 children undergoing elective tonsillectomy (with/without adenoidectomy), those with a postoperative vomiting score ≥ 4 were randomised into Group C (saline) and Group L (lidocaine). The primary outcome was the incidence of POV at 24 hours postoperatively. The secondary outcome was the number of coughs at 30 minutes postoperatively. The POV incidence differed with 15 patients in Group C (14.7%) and 5 in Group L (4.9%) presenting with one or more episodes of POV (P = 0.019). The number of coughs at 30 minutes postoperatively differed between Group L (1[0–2]) and Group C (1[0–2]) (P = 0.007). A lower percentage of patients experienced adverse events in Group C (2.2%) compared with Group L (1.1%) (P = 0.567); no severe events occurred. Adding lidocaine to ondansetron and dexamethasone is effective in reducing the POV incidence and extubation coughs in high-risk children following volatile anaesthesia for tonsillectomy.