Queen Elizabeth Hospital, University of Birmingham, UK.
Clin Otolaryngol. 2011 Dec;36(6):531-42. doi: 10.1111/j.1749-4486.2011.02373.x.
Tonsillectomy is one of the most common surgical procedures, but there is debate whether systemic steroids should be used to reduce pain and post-operative complications.
To determine whether peri-operative steroids reduce post-tonsillectomy pain and complications in adults.
Systematic review and meta-analysis of randomised controlled trials.
We searched MEDLINE (1950-2010), EMBASE (1980-2010), CINAHL (1981-2010), Web of Science, ProQuest, metaRegister, Conference Proceedings Citation Index, the Cochrane Library and reference lists of relevant studies.
Two reviewers independently selected trials and extracted data on their quality, characteristics and results. Trials included adults (age >16 years) undergoing elective tonsillectomy where peri-operative steroids were used, and the results were compared with control or placebo.
There were seven randomised controlled trials (580 patients) reporting post-operative pain. Meta-analysis demonstrates that dexamethasone in adults reduces the pain level experienced in the first post-tonsillectomy day [standard mean difference (SMD): -0.63, 95% CI: -1.13 to -0.12] with significant heterogeneity (I(2) = 84%, P < 0.00001). Sub-group analysis to explore heterogeneity demonstrated this reduction in pain was mostly with high total dose steroids (total >10 mg over first 24 h post-operatively; SMD: -1.48, 95% CI: -2.17 to -0.79, P < 0.00001), especially when given both intra-operatively and post-operatively. There was no significant effect with low doses (SMD: -0.12, 95% CI: -0.36 to 0.13, P = 0.35). There were three trials (231 patients) that reported post-operative nausea and vomiting, three other trials (270 patients) reporting on bleeding and three trials (401 patients) reporting other complications (infections and odynophagia). There was a significant reduction in post-operative nausea and vomiting (RR: 0.53, 95% CI: 0.36 to 0.80, P = 0.002, I(2) = 26%) and bleeding (RR: 0.45, 95% CI: 0.25 to 0.80, P = 0.007, I(2) = 0%), but the reduction in the other complications did not reach statistical significance (RR: 0.69, 95% CI: 0.48 to 1.01, P = 0.06, I(2) = 0%). Pooling of these complications (post-operative nausea and vomiting, bleeding, infections and odynophagia) shows that in six trials (501 patients), the use of dexamethasone significantly reduced post-operative complications following tonsillectomy in adults (RR: 0.59, 95% CI: 0.49 to 0.71, P < 0.00001, I(2) = 0%), when compared with placebo or control.
Dexamethasone reduces pain, post-operative nausea and vomiting, bleeding and overall post-operative complications in adults undergoing tonsillectomy. However, the effect of the dose of dexamethasone on post-operative pain and whether dexamethasone reduces bleeding require further research.
扁桃体切除术是最常见的手术之一，但对于是否应使用全身类固醇来减轻疼痛和术后并发症存在争议。
确定围手术期使用类固醇是否能减轻成年人扁桃体切除术后的疼痛和并发症。
随机对照试验的系统性评价和荟萃分析。
我们检索了 MEDLINE（1950-2010 年）、EMBASE（1980-2010 年）、CINAHL（1981-2010 年）、Web of Science、ProQuest、metaRegister、会议论文引文索引、Cochrane 图书馆和相关研究的参考文献列表。
两位评审员独立选择试验，并提取其质量、特征和结果数据。试验纳入了接受择期扁桃体切除术的成年人（年龄>16 岁），并比较了围手术期使用类固醇与对照组或安慰剂的结果。
有 7 项随机对照试验（580 名患者）报告了术后疼痛。荟萃分析显示，地塞米松可降低成年人扁桃体切除术后第一天的疼痛程度[标准均数差（SMD）：-0.63，95%置信区间（CI）：-1.13 至-0.12]，存在显著的异质性（I²=84%，P<0.00001）。亚组分析以探索异质性表明，这种疼痛减轻主要与高总剂量类固醇有关（总剂量>术后 24 小时内 10mg；SMD：-1.48，95%CI：-2.17 至-0.79，P<0.00001），尤其是术中及术后均给予时。低剂量（SMD：-0.12，95%CI：-0.36 至 0.13，P=0.35）则没有显著效果。有 3 项试验（231 名患者）报告了术后恶心和呕吐，3 项试验（270 名患者）报告了出血，3 项试验（401 名患者）报告了其他并发症（感染和咽痛）。术后恶心和呕吐（RR：0.53，95%CI：0.36 至 0.80，P=0.002，I²=26%）和出血（RR：0.45，95%CI：0.25 至 0.80，P=0.007，I²=0%）的发生率显著降低，但其他并发症的减少未达到统计学意义（RR：0.69，95%CI：0.48 至 1.01，P=0.06，I²=0%）。对这些并发症（术后恶心和呕吐、出血、感染和咽痛）进行汇总显示，在 6 项试验（501 名患者）中，与安慰剂或对照组相比，使用地塞米松可显著降低成年人扁桃体切除术后的术后并发症发生率（RR：0.59，95%CI：0.49 至 0.71，P<0.00001，I²=0%）。
地塞米松可减轻成年人扁桃体切除术后的疼痛、术后恶心和呕吐、出血和总体术后并发症。然而，地塞米松的剂量对术后疼痛的影响以及地塞米松是否减少出血还需要进一步研究。
