The effect of IV dexamethasone versus local anesthetic infiltration technique in postoperative nausea and vomiting after tonsillectomy in children: A randomized double-blind clinical trial

Int J Pediatr Otorhinolaryngol. 2017 Jan:92:21-26. doi: 10.1016/j.ijporl.2016.10.030. Epub 2016 Oct 28.

Abstract

Background: Local anesthetic infiltration and corticosteroids had shown effectiveness in reducing post tonsillectomy nausea, vomiting and pain.

Objectives: To compare the effect of intravenous dexamethasone versus pre-incision infiltration of local anesthesia in pediatric tonsillectomy on postoperative nausea and vomiting (PONV). The secondary objective was postoperative pain.

Methods: A randomized double-blind clinical trial was conducted at a tertiary care teaching hospital. Children admitted to undergo tonsillectomy aged between 4 and 13 years from January 2015 to August 2015 were enrolled and divided into two groups. Both groups had general anesthesia. Group I received intravenous dexamethasone 0.5 mg/kg (maximum dose 16 mg) with placebo pre-incision infiltration. Group II received pre-incision infiltration a total of 2-4 ml local anesthesia mixture with saline and an equivalent volume of intravenous saline.

Results: Group I consisted of 64 patients while group II had 65 patients. In the PACU, 15.6% of patients in group I experienced vomiting compared to 3.1% in group II (p-value = 0.032). After 24 h, the incidence of PONV was significantly higher in group I compared to group II (26.6% vs. 9.2% respectively, p-value = 0.019). At 48 h postoperatively, PONV was significantly higher in group I (p-value = 0.013). The incidence was similar in both groups after three, four and five postoperative days. Baseline pain and pain during swallowing were significantly different at 6, 12 and 24 h as well as days 1 through 5. Pain upon jaw opening was significantly different at 6, 12 and 24 h between the two groups. Pain while eating soft food was significantly different at 24 h and days 2 through 5. In the PACU, 20.3% of patients in group I received diclofenac compared to 3.1% in group II (p-value = 0.005). From day 1 till day 5, analgesic consumption was significantly higher in group I.

Conclusion: Local anesthetic infiltration in addition to NSAIDS and paracetamol could serve as a multimodal analgesia and decrease PONV.

Trial registration: NCT02355678.

Keywords: Analgesics; Corticosteroids; Local infiltration; Pain; Postoperative vomiting.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Acetaminophen / therapeutic use
  • Administration, Intravenous
  • Adolescent
  • Analgesics, Non-Narcotic / therapeutic use
  • Anesthesia, Local
  • Anesthetics, Local / therapeutic use*
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Antiemetics / administration & dosage
  • Antiemetics / therapeutic use*
  • Child
  • Child, Preschool
  • Dexamethasone / administration & dosage
  • Dexamethasone / therapeutic use*
  • Diclofenac / therapeutic use
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Pain Measurement / methods
  • Pain, Postoperative / etiology
  • Pain, Postoperative / prevention & control*
  • Postoperative Nausea and Vomiting / etiology
  • Postoperative Nausea and Vomiting / prevention & control*
  • Time Factors
  • Tonsillectomy / adverse effects*

Substances

  • Analgesics, Non-Narcotic
  • Anesthetics, Local
  • Anti-Inflammatory Agents, Non-Steroidal
  • Antiemetics
  • Diclofenac
  • Acetaminophen
  • Dexamethasone

Associated data

  • ClinicalTrials.gov/NCT02355678