Comparison of Local and Intravenous Dexamethasone for Postoperative Pain and Recovery after Tonsillectomy

Abstract

Objective To compare local infiltration of dexamethasone to intravenous injection for postoperative pain and recovery after tonsillectomy. Study Design Prospective, randomized study. Setting Second Affiliated Hospital of Harbin Medical University. Subjects and Methods Children (n = 240, American Society of Anesthesiologists [ASA] classes I-II, aged 5-10 y) scheduled for tonsillectomy were randomly and equally assigned to 3 groups: DEX-IV, for intravenous injection of dexamethasone (0.5 mg/kg, maximum dose 24 mg); DEX-INF, given the same amount of dexamethasone by local infiltration to the upper middle and lower poles of the tonsils; and a control group not given dexamethasone. Postoperative pain was scored at intervals from 30 minutes to 24 hours. The time to first administration of analgesic and average consumption of analgesic, times to first oral water and solid food intake, and incidence rates of nausea and vomiting were evaluated. Results From postoperative 1 to 16 hours, the DEX-INF group had significantly lower pain scores than did the DEX-IV group, and the time to first analgesic and average consumption of analgesic were also significantly lower. The times to first oral water and food intake in the DEX-INF group were significantly shorter than in the DEX-IV group. The incidence of nausea and vomiting in the DEX-INF group was higher than that of the DEX-IV group. Conclusion Local infiltration of dexamethasone was more effective than systemic administration to decrease pain and time to food intake, but the antiemetic effect was less. Clinical trials registration number: ChiCTR-TRC-13003535.