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
Loading...
Date
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier Ireland Ltd
Abstract
Background Local anesthetic infiltration and corticosteroids had shown effectiveness in reducing post tonsillectomy nausea, vomiting and pain. Objectives To 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. Methods A 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. Results Group 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. Conclusion Local anesthetic infiltration in addition to NSAIDS and paracetamol could serve as a multimodal analgesia and decrease PONV. Trial registration NCT02355678. © 2016
Description
Keywords
Analgesics, Corticosteroids, Local infiltration, Pain, Postoperative vomiting, Acetaminophen, Administration, intravenous, Adolescent, Analgesics, non-narcotic, Anesthesia, local, Anesthetics, local, Anti-inflammatory agents, non-steroidal, Antiemetics, Child, Child, preschool, Dexamethasone, Diclofenac, Dose-response relationship, drug, Double-blind method, Female, Humans, Male, Pain measurement, Pain, postoperative, Postoperative nausea and vomiting, Time factors, Tonsillectomy, Bupivacaine, Clonidine, Epinephrine, Fentanyl, Lidocaine, Local anesthetic agent, Paracetamol, Placebo, Analgesic agent, Antiemetic agent, Nonsteroid antiinflammatory agent, Analgesia, Article, Comparative effectiveness, Controlled study, Corticosteroid therapy, Double blind procedure, Dysphagia, Food intake, General anesthesia, Human, Jaw opening reflex, Local anesthesia, Major clinical study, Nausea, Postoperative complication, Postoperative pain, Priority journal, Randomized controlled trial, Vomiting, Adverse effects, Comparative study, Dose response, Intravenous drug administration, Preschool child, Procedures, Time factor