Chernkwan Titirungruang1, K Seresirikachorn2, P Kasemsuwan2, P Hirunwiwatkul2. 1. Department of Otolaryngology, King Chulalongkorn Memorial Hospital, 1873 Rama 4 road, Pathumwan, Bangkok, 10330, Thailand. c.titirungruang@gmail.com. 2. Department of Otolaryngology, King Chulalongkorn Memorial Hospital, 1873 Rama 4 road, Pathumwan, Bangkok, 10330, Thailand.
Abstract
OBJECTIVES: To systemically review and compare the efficacy of intravenous, local, and oral steroids in decreasing post-tonsillectomy pain, nausea, and vomiting, and its risk of causing hemorrhage. METHODS: We searched electronic databases (PubMed, Scopus, Cochrane Library) and additional sources. The date of the most recent search was June 20th, 2018. We selected RCTs of steroids in all routes of administration, in all age groups who underwent tonsillectomy or adenotonsillectomy and studied the results of nausea/vomiting, pain, and hemorrhage. Data analysis was done using Review Manager 5.3.5 software. RESULTS: We included 64 studies (6,327 participants) with variety quality assessed by the Cochrane Handbook for Systematic Reviews of Interventions. IV steroids statistically and clinically significant decrease post-tonsillectomy nausea/vomiting in children and adult, with superior effect to local steroids (Children: OR 0.21; 95% CI 0.15-0.30; P < 0.001, I2 = 67%, Adult: OR 0.32; 95% CI 0.16-0.67; P = 0.002, I2 = 40%). In the analysis of local steroids studies, there was only evidence in children that local steroids decrease post-tonsillectomy nausea/vomiting (OR 0.54; 95% CI 0.33-0.88; P = 0.01, I2 = 32%). IV and local steroids statistically significant decrease immediate post-operative pain severity. Local steroids had extended effect in reducing pain scores on the first day after tonsillectomy. However, the clinical significance of pain relief had to be concerned due to decreasing VAS only about 1 out of 10. Adding oral steroids to IV steroids gave no difference in effect from IV steroids alone. There are very few local steroids studies in adults and oral steroids studies to show the significant effects. Steroids have no statistically significant effect in reducing pain severity after a 1-day period. Steroids in all routes had no statistically significant effects on post-operative hemorrhage (primary hemorrhage: OR 0.96; 95% CI 0.55-1.67; P = 0.88, I2 = 0%; secondary hemorrhage: OR 1.05; 95% CI 0.74-1.51; P = 0.79, I2 = 0%). CONCLUSION: Intravenous steroids statistically significantly decrease post-tonsillectomy nausea/vomiting, and immediate pain scores (< 24 h) in children and adults. There is evidence in only children that local steroids statistically significantly decreases post-tonsillectomy nausea/vomiting, and pain scores during the 0-h to 1-day period.
OBJECTIVES: To systemically review and compare the efficacy of intravenous, local, and oral steroids in decreasing post-tonsillectomy pain, nausea, and vomiting, and its risk of causing hemorrhage. METHODS: We searched electronic databases (PubMed, Scopus, Cochrane Library) and additional sources. The date of the most recent search was June 20th, 2018. We selected RCTs of steroids in all routes of administration, in all age groups who underwent tonsillectomy or adenotonsillectomy and studied the results of nausea/vomiting, pain, and hemorrhage. Data analysis was done using Review Manager 5.3.5 software. RESULTS: We included 64 studies (6,327 participants) with variety quality assessed by the Cochrane Handbook for Systematic Reviews of Interventions. IV steroids statistically and clinically significant decrease post-tonsillectomy nausea/vomiting in children and adult, with superior effect to local steroids (Children: OR 0.21; 95% CI 0.15-0.30; P < 0.001, I2 = 67%, Adult: OR 0.32; 95% CI 0.16-0.67; P = 0.002, I2 = 40%). In the analysis of local steroids studies, there was only evidence in children that local steroids decrease post-tonsillectomy nausea/vomiting (OR 0.54; 95% CI 0.33-0.88; P = 0.01, I2 = 32%). IV and local steroids statistically significant decrease immediate post-operative pain severity. Local steroids had extended effect in reducing pain scores on the first day after tonsillectomy. However, the clinical significance of pain relief had to be concerned due to decreasing VAS only about 1 out of 10. Adding oral steroids to IV steroids gave no difference in effect from IV steroids alone. There are very few local steroids studies in adults and oral steroids studies to show the significant effects. Steroids have no statistically significant effect in reducing pain severity after a 1-day period. Steroids in all routes had no statistically significant effects on post-operative hemorrhage (primary hemorrhage: OR 0.96; 95% CI 0.55-1.67; P = 0.88, I2 = 0%; secondary hemorrhage: OR 1.05; 95% CI 0.74-1.51; P = 0.79, I2 = 0%). CONCLUSION: Intravenous steroids statistically significantly decrease post-tonsillectomy nausea/vomiting, and immediate pain scores (< 24 h) in children and adults. There is evidence in only children that local steroids statistically significantly decreases post-tonsillectomy nausea/vomiting, and pain scores during the 0-h to 1-day period.