The effect of IV dexamethasone versus local anesthetic infiltration technique in postoperative nausea and vomiting after tonsillectomy in children: A randomized double-blind clinical trial

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• 作者：Zoher Naja^a ; ^{zouhnaja@yahoo.com} ; Saleh Kanawati^a ; Rania Al Khatib^a ; Fouad Ziade^b ; Zeina Z. Naja^c ; Ahmad Salah Naja^d ; Mariam Rajab^e
• 关键词：Local infiltration ; Corticosteroids ; Postoperative vomiting ; Pain ; Analgesics
• 刊名：International Journal of Pediatric Otorhinolaryngology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：92
• 期：Complete
• 页码：21-26
• 全文大小：564 K
• 卷排序：92

文摘

Local anesthetic infiltration and corticosteroids had shown effectiveness in reducing post tonsillectomy nausea, vomiting and pain.ObjectivesTo compare the effect of intravenous dexamethasone versus pre-incision infiltration of local anesthesia in pediatric tonsillectomy on postoperative nausea and vomiting (PONV). The secondary objective was postoperative pain.MethodsA randomized double-blind clinical trial was conducted at a tertiary care teaching hospital. Children admitted to undergo tonsillectomy aged between 4 and 13 years from January 2015 to August 2015 were enrolled and divided into two groups. Both groups had general anesthesia. Group I received intravenous dexamethasone 0.5 mg/kg (maximum dose 16 mg) with placebo pre-incision infiltration. Group II received pre-incision infiltration a total of 2–4 ml local anesthesia mixture with saline and an equivalent volume of intravenous saline.ResultsGroup I consisted of 64 patients while group II had 65 patients. In the PACU, 15.6% of patients in group I experienced vomiting compared to 3.1% in group II (p-value = 0.032). After 24 h, the incidence of PONV was significantly higher in group I compared to group II (26.6% vs. 9.2% respectively, p-value = 0.019). At 48 h postoperatively, PONV was significantly higher in group I (p-value = 0.013). The incidence was similar in both groups after three, four and five postoperative days.Baseline pain and pain during swallowing were significantly different at 6, 12 and 24 h as well as days 1 through 5. Pain upon jaw opening was significantly different at 6, 12 and 24 h between the two groups. Pain while eating soft food was significantly different at 24 h and days 2 through 5.In the PACU, 20.3% of patients in group I received diclofenac compared to 3.1% in group II (p-value = 0.005). From day 1 till day 5, analgesic consumption was significantly higher in group I.ConclusionLocal anesthetic infiltration in addition to NSAIDS and paracetamol could serve as a multimodal analgesia and decrease PONV.Trial registrationNCT02355678.