Does the administration of systemic steroids during the post-operative course affect the morbidity associated with tonsillectomy surgery?
Background: Tonsillectomy is one of the most common surgical procedures performed in North America. Despite the various technical options for performing this procedure, patients undergoing tonsillectomy endure significant morbidity. Common issues after tonsillectomy include pain, nausea and vomiting. Intraoperative administration of dex-ametheasone has been demonstrated to have a beneficial effect after tonsillectomy. However, the efficacy of steroids to reduce morbidity during the post-operative course has not been validated.
Explore this issue:November 2012
Study design: Randomized, placebo-controlled, double-blinded trial.
Setting: University hospital and private hospital.
Synopsis: The authors compared a five-day course of prednisolone versus a placebo in a pediatric population (aged 3 to 16 years) undergoing tonsillectomy to assess the effects on post-operative pain, nausea, vomiting, return to normal function, sleep duration and aspects of sleep quality. Patients in the steroid arm received doses that ranged from 0.5 mg/kg of prednisolone to a maximum of 20 mg/kg daily. Standard surgical technique was employed on all patients. Ninety-one patients in the steroid arm and 102 patients in the placebo arm completed the study. There was no significant difference between the steroid and placebo group with regard to pain, nausea and vomiting, return to normal diet, sleep duration or in the number of times the patients awoke during the night, for the first eight days following surgery.
The strengths of the study are in the randomized, double-blinded study design and the cohort size. The weaknesses of the study are the subjective nature of the parameters assessed and the method by which the data was collected (parents filled out a questionnaire).
Bottom line: Though intraoperative steroids seem to have a beneficial effect, the use of steroids during the post-operative period does not seem to reduce tonsillectomy-associated morbidity.
Citation: Macassey E, Dawes P, Taylor B, Gray A. The effect of a postoperative course of oral prednisone on postoperative morbidity following childhood tonsillectomy. Otolaryngol Head Neck Surg. 2012;147(3):551-556.