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Matthew M. Hanasono, MD; M. Lauren Lalakea, MD; Anthony A. Mikulec, MD; Kimberly G. Shepard, MD; Vinit Wellis, MD; Anna H. Messner, MD

Arch Otolaryngol Head Neck Surg. 2004;130:917-921.

Objective  To determine the effect of preoperative dexamethasone sodium phosphate administration on posttonsillectomy morbidity for electrocautery ("hot") and sharp ("cold") dissection techniques.

Design  Prospective, randomized, double-blind study.

Setting  University pediatric hospital and county teaching hospital.

Subjects  A total of 219 children, aged 9 months to 12 years, undergoing tonsillectomy.

Intervention  Participants who underwent tonsillectomy were randomly assigned to receive either intravenous dexamethasone sodium phosphate (1 mg/kg) or placebo.

Outcome Measures  Pain scores, oral intake, and emesis on postoperative day (POD) 1.

Results  A total of 106 subjects (62 undergoing hot and 44 cold tonsillectomies) received preoperative steroids, and 113 (56 hot and 57 cold tonsillectomies) received placebo. On POD 1, pain scores reported by patients (P = .02), parents (P = .002), and physicians (P<.001) were significantly lower in subjects receiving steroids than in those receiving placebo. Emesis was reduced from a mean of 2.1 (placebo group) to 1.2 episodes (steroid group) (P = .02). Oral intake improved from 24.5% of normal diet (placebo) to 31.7% (steroid group) (P = .004). When all 4 groups were compared (cold placebo, cold steroid, hot placebo, and hot steroid), pain scores reported by physicians and parents were significantly lower in the cold steroid group than in the other groups.

Conclusions  Perioperative dexamethasone use reduces posttonsillectomy morbidity in pediatric patients in the early postoperative period after hot or cold tonsillectomy. The combination of steroid and cold dissection technique provided the greatest advantage in reducing posttonsillectomy subjective pain levels.

From the Departments of Otolaryngology–Head and Neck Surgery (Drs Hanasono, Lalakea, Mikulec, Shepard, Wellis, and Messner) and Pediatrics (Dr Messner), Stanford University Medical Center, Stanford, Calif; Division of Otolaryngology–Head and Neck Surgery, Santa Clara Valley Medical Center, San Jose, Calif (Drs Lalakea and Shepard). The authors have no relevant financial interest in this article.