Kaan M Nil, Odabasi Onur, Gezer Erdal, Daldal Alper
Adnan Menderes University, School of Medicine, Department of Anesthesiology and Reanimation, 09100 Aydin, Turkey.
Int J Pediatr Otorhinolaryngol. 2006 Jan;70(1):73-9. doi: 10.1016/j.ijporl.2005.05.013. Epub 2005 Jun 24.
Postoperative morbidity in patients undergoing tonsillectomy with or without adenoidectomy includes inadequate oral intake, pain, nausea, vomiting and bleeding. The purpose of this study is to evaluate the effect of preoperative 0.5 mg/kg i.v. dexamethasone on postoperative early oral intake, pain, vomiting in patients undergoing adenotonsillectomy while performing standard anesthesia technique and sharp dissection tonsillectomy.
In this prospective, double-blinded, placebo-controlled study 62 children, aged 4-12 years, who underwent tonsillectomy with or without adenoidectomy were randomly assigned to receive single dose of 0.5 mg/kg i.v. dexamethasone preoperatively. Patients started to receive 100 ml of clear fluids 2 h postoperatively, then were offered every hour. When pain score was 3 or above, paracetamol was given for pain control. Tolerating 400 ml of clear fluids, no bleeding and no vomiting were accepted as discharge criteria. The discharge time was also recorded. The incidence of early vomiting, pain scores, amount of oral intake were recorded until the discharge time.
Compared with placebo, the patients who received preoperative dexamethasone had significantly less pain score during the first 6 h postoperatively (p<0.05), adequate amount of oral intake time was shorter (p<0.05) and the discharge time was earlier (p<0.05). No difference was found in vomiting incidence in both groups.
Preoperative dexamethasone use significantly reduces early posttonsillectomy pain, improves oral intake and facilitates meeting the discharge criteria while using standard anesthesia technique and sharp dissection tonsillectomy without any significant side effects.
接受扁桃体切除术（无论是否同时行腺样体切除术）的患者术后并发症包括经口摄入量不足、疼痛、恶心、呕吐和出血。本研究旨在评估在采用标准麻醉技术和扁桃体锐性剥离术的情况下，术前静脉注射0.5mg/kg地塞米松对接受腺样体扁桃体切除术患者术后早期经口摄入量、疼痛及呕吐的影响。
在这项前瞻性、双盲、安慰剂对照研究中，62名年龄在4至12岁之间、接受了扁桃体切除术（无论是否同时行腺样体切除术）的儿童被随机分配在术前接受单剂量0.5mg/kg静脉注射地塞米松。患者术后2小时开始接受100ml的清亮液体，然后每小时给予一次。当疼痛评分达到3分或更高时，给予对乙酰氨基酚以控制疼痛。以能够耐受400ml清亮液体、无出血且无呕吐作为出院标准。同时记录出院时间。记录直至出院时早期呕吐的发生率、疼痛评分及经口摄入量。
与安慰剂组相比，术前接受地塞米松的患者在术后前6小时疼痛评分显著更低（p<0.05），经口摄入量充足的时间更短（p<0.05），出院时间更早（p<0.05）。两组呕吐发生率无差异。
在采用标准麻醉技术和扁桃体锐性剥离术时，术前使用地塞米松可显著减轻扁桃体切除术后早期疼痛，改善经口摄入量，并有助于达到出院标准，且无任何显著副作用。
