The effect of postoperative steroids on post-tonsillectomy pain and need for postoperative physician contact

Laryngoscope. 2018 Sep;128(9):2187-2192. doi: 10.1002/lary.27167. Epub 2018 Mar 24.

Abstract

Objectives/hypothesis: Examine the effect of postoperative steroids on postoperative physician contacts and determine the hemorrhage rate for patients taking postoperative steroids.

Study design: Retrospective review of medical records.

Methods: A retrospective review was performed of children undergoing tonsillectomies before and after the institution of a standard postoperative course of three doses of dexamethasone (0.5 mg/kg). Tylenol and ibuprofen were also used for all patients, with oxycodone given as a rescue medication for children ≥6 years of age. Postoperative hemorrhage rate (all visits to the emergency department [ED] with concern for post-tonsillectomy hemorrhage), return to the ED for pain, and phone calls to the office for pain were recorded.

Results: A total of 1,200 children were included (300 without and 900 with steroids); there was no difference in age or weight between groups. Overall, the mean age was 6.6 ± 2.1 years and the hemorrhage rate was 7%. Parental phone calls decreased from 23.3% prior to steroid use to 14.7% after (P < .001), and post-tonsillectomy hemorrhage rates decreased from 9.7% to 5.7% (P = .02). There was no difference in ED visit rates (P = 0.70). Regression analysis showed that bleeding increased by 4% (95% confidence interval [CI]: 1%-13%) for each increasing year of age (P < .001), whereas postoperative steroids decreased hemorrhage rates by 7% (95% CI: 1%-9% reduction) (P = .013). The risk of a phone call increased by 2% for each year of age; postoperative steroids decreased phone calls by 9% (P < .001). There were no steroid-related complications within 1 month of surgery.

Conclusions: A short course of postoperative steroids decreased the number of postoperative phone calls for pain by 9% after tonsillectomy, and decreased the risk of postoperative tonsillectomy hemorrhage by 7%.

Level of evidence: 4. Laryngoscope, 128:2187-2192, 2018.

Keywords: Tonsillectomy; pediatric otolaryngology; postoperative pain; steroids.

MeSH terms

  • Acetaminophen / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Dexamethasone / therapeutic use
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Humans
  • Ibuprofen / therapeutic use
  • Male
  • Pain, Postoperative / drug therapy*
  • Postoperative Hemorrhage / epidemiology
  • Postoperative Hemorrhage / etiology
  • Postoperative Period
  • Retrospective Studies
  • Steroids / therapeutic use*
  • Tonsillectomy / adverse effects*
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents
  • Steroids
  • Acetaminophen
  • Dexamethasone
  • Ibuprofen