The effect of a postoperative course of oral prednisone on postoperative morbidity following childhood tonsillectomy.

OBJECTIVE: Tonsillectomy is a common procedure with a wide range of described operative techniques and usage of perioperative medications. Single-dose intraoperative dexamethasone has been shown to decrease postoperative nausea and pain and improve return to normal diet. The aim was to determine if a course of oral postoperative steroids would further decrease postoperative morbidity following tonsillectomy in children. STUDY DESIGN: Randomized, placebo-controlled, double-blinded trial. Power analysis recommended 198 participants. SETTING: A university hospital and private hospital. SUBJECTS AND METHODS: The authors compared a 5-day course of oral prednisolone with placebo in a pediatric population (3-16 years) undergoing tonsillectomy to assess effects on postoperative pain, nausea, and vomiting and return to normal function. They also assessed the effect of corticosteroids on sleep duration and aspects of sleep quality. RESULTS: The results showed no significant difference between the 2 groups when analyzed for differences in the above variables both overall and at each of the postoperative 10 time points (pain, P = .478; nausea and vomiting, P = .556; return to normal diet well, P = .234; return to normal activity, P = .668; bedtime, P = .056; number of times awake during the night, P = .593). CONCLUSION: There is no evidence of benefit from postoperative administration of corticosteroids in pediatric patients recovering from tonsillectomy.

15-year audit of post-tonsillectomy haemorrhage at Dunedin Hospital.

Post-tonsillectomy haemorrhage is a significant complication because of its frequency and consequences. Increases in post-tonsillectomy haemorrhage prevalence have been reported. There is a controversy about whether increasing the use of diathermy techniques or anti-platelet aggregation effects of analgesia could have caused this increase. We carried out an audit of post-tonsillectomy haemorrhage and examined the rates of readmission for bleeding during the period 1990-2004. We also recorded the surgical technique used and the use of perioperative non-steroidal anti-inflammatory drugs and corticosteroids. During this period there has been a significant increase in post-tonsillectomy haemorrhage with an average annual increase of 15.3% (P<0.0001, 95% confidence interval 8.5-22.5%). The increase is coincidental with the change-over to predominant diathermy technique and a routine use of postoperative non-steroidal anti-inflammatory drugs and steroids.