Role of Dexamethasone in Post-tonsillectomy Morbidities

Objective: The aim of this study was to find out the effect of Dexamethasone on pain following tonsillectomy. In addition topost-tonsillectomy pain, this study also explore the comparative outcome of use of additional analgesic, fever, nausea &vomiting as well as oral intake of semisolid food between the groups. Methods: A double blind, randomized control trial using a single pre-operative dose of Dexamethasone (0.15mg/kg bodyweight) or normal saline in the randomly selected 100 patients of age more than 3 years, undergoing tonsillectomy fulfillinginclusion criteria of this study, in the Department of Otolaryngology and head Neck surgery, Dhaka Medical College Hospital,Dhaka during July 2009 to June 2010. Surgical techniques, anesthetic drugs, use of analgesic and other medication werestandardized. Both groups were assessed clinically at 6, 12 and 24 hours post-operatively for pain, requirement of analgesic,fever, nausea & vomiting, oral intake, condition of the tonsillar fossa and reactionary haemorrhage. Visual Analogue Scale(VAS) used for the assessment of pain. Results: Post-operative pain was assessed by Visual Analogue Scale (VAS) in both Dexamethasone and Control groups.Mean+/-SD of the VAS in Dexamethasone and Control groups at 6 hours was 5.04 +/- 1.09 vs 5.96 +/- 1.03 (p= < 0.0001), at 12hours was 3.94 +/- 0.93 vs 5.14 +/- 0.61 (p=< 0.0001) and at 24 hours was 2.64 +/- 0.69 vs 3.84 +/- 0.87 (p=< 0.0001). Requirement ofadditional analgesic (p<0.05), fever (P<0.001), Post-Operative Nausea and Vomiting (PONV) (P < 0.005), oral intake ofsemisolid food (P<0.005) between Dexamethasone and control group were significantly different. Regarding condition of thetonsillar fossa and reactionary haemorrhage, no significant differences were observed. Conclusion: A single preoperative IV dose of Dexamethasone (0.15 mg/kg), given just before starting surgery, provided goodand prolonged analgesia. It also reduces fever, nausea & vomiting and odynophagia. Those enhance earlier and betterpostoperative quality of oral intake and decrease morbidities.