Role of Preoperative Dexamethasone in Post Tonsillectomy Pain and Vomiting

Abstract

Background: Tonsillectomy is one of the most common surgical procedures of childhood, is complicated by postoperative pain and vomiting and thus causes significant morbidity with resulting delay in recovery. Different pharmacologic approaches, both systemic and topical, both before and after surgery, have been tried for reducing such complications. Dexamethasone, because of its anti-inflammatory and antiemetic activity, has come into prominence as a potential useful adjunct in the perioperative period. Objective: To compare the frequency of postoperative vomiting and pain with dexamethasone and placebo in tonsillectomy. Study Design: Randomized controlled trial. Duration and Place of Study: This trial was conducted in the Department of Otorhinolaryngology, CMH Jhelum, from January 2023 to July 2023. Methodology: A total of 160 children aged 4–12 years undergoing elective tonsillectomy were randomly allocated into two equal groups. Group A received dexamethasone 0.5 mg/kg (maximum 8 mg), while Group B received placebo. A standardized anesthetic protocol was followed, and all surgeries were performed using electro dissection. Postoperative vomiting was defined as three or more forceful episodes within four hours of extubation, while pain was assessed at intervals up to 24 hours using the Faces Visual Analogue Scale, with scores above 4 indicating significant pain. Results: Vomiting was significantly lower in the dexamethasone group (13.8%) compared with placebo (42.5%, p=0.000). Pain was also reduced, occurring in 42.5% of Group A versus 70% of Group B (p=0.001). Stratified analysis showed stronger benefits in younger children and those weighing ≤30 kg. Conclusion: Preoperative dexamethasone significantly reduces postoperative vomiting and pain in pediatric tonsillectomy, making it a safe and effective adjunct to improve recovery outcomes.