Titirungruang Chernkwan, Seresirikachorn K, Kasemsuwan P, Hirunwiwatkul P
Department of Otolaryngology, King Chulalongkorn Memorial Hospital, 1873 Rama 4 road, Pathumwan, Bangkok, 10330, Thailand.
Eur Arch Otorhinolaryngol. 2019 Feb;276(2):585-604. doi: 10.1007/s00405-018-5202-2. Epub 2018 Nov 17.
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.
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.
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, I = 67%, Adult: OR 0.32; 95% CI 0.16-0.67; P = 0.002, I = 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, I = 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, I = 0%; secondary hemorrhage: OR 1.05; 95% CI 0.74-1.51; P = 0.79, I = 0%).
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.
系统评价并比较静脉注射、局部应用及口服类固醇激素在减轻扁桃体切除术后疼痛、恶心和呕吐方面的疗效及其导致出血的风险。
我们检索了电子数据库（PubMed、Scopus、Cochrane图书馆）及其他来源。最近一次检索日期为2018年6月20日。我们选择了所有年龄组接受扁桃体切除术或腺样体扁桃体切除术且采用各种给药途径使用类固醇激素的随机对照试验，并研究恶心/呕吐、疼痛和出血的结果。使用Review Manager 5.3.5软件进行数据分析。
我们纳入了64项研究（6327名参与者），其质量由《Cochrane干预系统评价手册》评估。静脉注射类固醇激素在统计学和临床上均显著降低儿童和成人扁桃体切除术后的恶心/呕吐，效果优于局部应用类固醇激素（儿童：OR 0.21；95%CI 0.15 - 0.30；P < 0.001，I = 67%，成人：OR 0.32；95%CI 0.16 - 0.67；P = 0.002，I = 40%）。在局部应用类固醇激素的研究分析中，仅在儿童中有证据表明局部应用类固醇激素可降低扁桃体切除术后的恶心/呕吐（OR 0.54；95%CI 0.33 - 0.88；P = 0.01，I = 32%）。静脉注射和局部应用类固醇激素在统计学上显著降低术后即刻疼痛严重程度。局部应用类固醇激素在扁桃体切除术后第一天有延长的减轻疼痛评分的作用。然而，由于视觉模拟评分法（VAS）仅降低约十分之一，疼痛缓解的临床意义仍需关注。静脉注射类固醇激素联合口服类固醇激素与单独使用静脉注射类固醇激素的效果无差异。成人局部应用类固醇激素的研究和口服类固醇激素的研究很少显示出显著效果。类固醇激素在术后1天以上对减轻疼痛严重程度无统计学显著效果。所有给药途径应用类固醇激素对术后出血均无统计学显著影响（原发性出血：OR 0.96；95%CI 0.55 - 1.67；P =
