Niimi Naoko, Sumie Makoto, Englesakis Marina, Yang Alan, Olsen Julia, Cheng Richard, Maynes Jason T, Campisi Paolo, Hayes Jason, Ng William C K, Aoyama Kazuyoshi
Department of Anesthesia and Pain Medicine, The Hospital for Sick Children (SickKids), Toronto, ON, Canada.
Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.
Can J Anaesth. 2025 Jan;72(1):106-118. doi: 10.1007/s12630-024-02817-y. Epub 2024 Aug 27.
Tonsillectomy is one of the most common ambulatory procedures performed in children worldwide, with around 40,000 procedures performed in Canada every year. Although a prior systematic review indicated a clear role for dexamethasone as an analgesic adjunct, the quantity effect on opioid consumption is unknown. In the current systematic review with meta-analysis, we hypothesized that the use of dexamethasone reduces perioperative opioid consumption in pediatric tonsillectomy but does not increase rates of postoperative hemorrhage.
We systemically searched MEDLINE, Embase, Cochrane Databases, and Web of Science from inception to 23 April 2024. Randomized controlled trials that compared intravenous dexamethasone to placebo in pediatric tonsillectomy were included in the study. The primary outcome was perioperative opioid consumption, and the secondary outcomes included the incidence of postoperative hemorrhage. We used a random effects meta-analysis to compute the mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI) for each outcome.
Of the 1,329 studies identified in the search, we included 16 in the final analysis. Intravenous dexamethasone administration significantly reduced opioid consumption (MD, -0.11 mg·kg oral morphine equivalent; 95% CI, -0.22 to -0.01) without increasing the incidence of readmission (RR, 0.69; 95% CI, 0.28 to 1.67) or reoperation due to postoperative hemorrhage (RR, 3.67; 95% CI, 0.79 to 17.1).
Intravenous dexamethasone reduced perioperative opioid consumption in pediatric tonsillectomy without increasing the incidence of postoperative hemorrhage.
PROSPERO ( CRD42023440949 ); first submitted 4 September 2023.
扁桃体切除术是全球儿童最常见的门诊手术之一，加拿大每年约有40000例此类手术。尽管先前的一项系统评价表明地塞米松作为镇痛辅助药物有明确作用，但对阿片类药物消耗量的量效关系尚不清楚。在本次进行荟萃分析的系统评价中，我们假设使用地塞米松可减少小儿扁桃体切除术中围手术期阿片类药物的消耗，但不会增加术后出血率。
我们系统检索了从数据库建立至2024年4月23日的MEDLINE、Embase、Cochrane数据库和科学网。本研究纳入了在小儿扁桃体切除术中比较静脉注射地塞米松与安慰剂的随机对照试验。主要结局是围手术期阿片类药物的消耗量，次要结局包括术后出血的发生率。我们采用随机效应荟萃分析计算每个结局的平均差（MD）或风险比（RR）及95%置信区间（CI）。
在检索到的1329项研究中，我们最终纳入了16项。静脉注射地塞米松显著减少了阿片类药物的消耗（MD，-0.11mg·kg口服吗啡当量；95%CI，-0.22至-0.01），且未增加再次入院率（RR，0.69；95%CI，0.28至1.67）或因术后出血而再次手术的发生率（RR，3.67；95%CI，0.79至17.1）。
静脉注射地塞米松可减少小儿扁桃体切除术中围手术期阿片类药物的消耗，且不增加术后出血率。
PROSPERO（CRD42023440949）；于2023年9月4日首次提交。
