Steroids and emesis after tonsillectomy
Clinical bottom line
Steroids can reduce emesis in the first postoperative day after tonsillectomy. The number needed to treat to prevent one child with emesis was 3.7 (2.9 to 5.3).
DL Steward et al. Do steroids reduce morbidity of tonsillectomy? Meta-analysis of randomized trials. Laryngoscope 2001 111: 1712-1718.
The Cochrane Library and PubMed were searched for studies using steroids during tonsillectomy. Included trials were randomised, double blind, placebo controlled trials of a single dose of intraoperative corticosteroid for paediatric patients under 18 years undergoing tonsillectomy or adenoidectomy. Studies not in English were not included.
The outcomes were emetic events (including retching) in the first 24 hours.
There were eight studies with over 534 children initially included, all using dexamethasone intraoperatively at doses between 8 mg and 25 mg (0.15 to 1.0 mg/kg).
Emesis during the first 24 hours occurred in 73/259 (29%) of children given steroid and in 152/275 (55%) of children given placebo (Figure 1). The relative risk was 0.5 (0.4 to 0.6) and the number needed to treat to prevent one child with emesis was 3.7 (2.9 to 5.3).
Figure 1: Emesis with placebo and steroid in the first 24 hours after tonsillectomy.
This is an interesting paper limited by using only English language papers and its failure to refer to the extensive evidence base that exists for postoperative nausea and vomiting. The very considerable variability between studies in the rate of emesis with placebo (about 10% to 90%) is what is commonly seen in this clinical area, and it is not fully understood. It may reflect the relatively small size of the studies, or other factors not yet recognised as important.
It is worth reading this alongside the much larger analysis of dexamethasone for postoperative nausea and vomiting ( Henzi I, Walder B, Tramer MR. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 2000 Jan;90(1):186-94 )