title: 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.
abstract: BACKGROUND
  Local anesthetic infiltration and corticosteroids had shown effectiveness in reducing post tonsillectomy nausea, vomiting and pain.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Local anesthetic infiltration in addition to NSAIDS and paracetamol could serve as a multimodal analgesia and decrease PONV.
  
  
  BACKGROUND
  NCT02355678.
authors.affiliation: Anesthesia and Pain Management Department, Makassed General Hospital, Beirut, Lebanon. Electronic address: zouhnaja@yahoo.com.
authors.forename: Zoher
authors.initials: Z
authors.lastname: Naja
authors.affiliation: Anesthesia and Pain Management Department, Makassed General Hospital, Beirut, Lebanon.
authors.forename: Saleh
authors.initials: S
authors.lastname: Kanawati
authors.affiliation: Anesthesia and Pain Management Department, Makassed General Hospital, Beirut, Lebanon.
authors.forename: Rania
authors.initials: R
authors.lastname: Al Khatib
authors.affiliation: Faculty of Public Health, Lebanese University, Beirut, Lebanon.
authors.forename: Fouad
authors.initials: F
authors.lastname: Ziade
authors.affiliation: Pediatric Department, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Zeina Z
authors.initials: ZZ
authors.lastname: Naja
authors.affiliation: Medicine Department, Lebanese American University, Beirut, Lebanon.
authors.forename: Ahmad Salah
authors.initials: AS
authors.lastname: Naja
authors.affiliation: Pediatrics Department, Makassed General Hospital, Beirut, Lebanon.
authors.forename: Mariam
authors.initials: M
authors.lastname: Rajab
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D061605:Administration, Intravenous; D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000932:Antiemetics / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D004008:Diclofenac / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects*
chemical_list: D018712:Analgesics, Non-Narcotic; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000932:Antiemetics; D004008:Diclofenac; D000082:Acetaminophen; D003907:Dexamethasone
keywords: Analgesics; Corticosteroids; Local infiltration; Pain; Postoperative vomiting