Dexamethasone Cuts Opioid Use in Pediatric Tonsillectomy

TOPLINE:

The intraoperative administration of a single dose of dexamethasone in children undergoing tonsillectomy with general anesthesia reduces the perioperative consumption of opioids without increasing the risk for postoperative hemorrhage.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis to study the effect of intraoperative dexamethasone use on opioid consumption in children aged 18 years or younger undergoing tonsillectomy.
• They included 16 randomized controlled trials focusing on pediatric tonsillectomy under general anesthesia, where the participants received dexamethasone, with doses ranging from 0.15 mg/kg to 1.0 mg/kg, or placebo; one study reported a dosing regimen of 8 mg/m² dexamethasone.
• The primary outcome was perioperative opioid consumption, measured as oral morphine milligram equivalent in mg/kg; the secondary outcomes were postoperative hemorrhage and adverse respiratory events in the perioperative period.

TAKEAWAY:

• The administration of dexamethasone significantly reduced opioid consumption in pediatric tonsillectomy, with a mean difference of −0.11 mg/kg oral morphine equivalent (95% CI, −0.22 to −0.01).
• The administration of dexamethasone did not lead to an increase in the incidence of readmission (risk ratio [RR], 0.69; 95% CI, 0.28-1.67) or emergency reoperation (RR, 3.67; 95% CI, 0.79-17.14) due to postoperative hemorrhage.
• Only one study reported perioperative respiratory adverse events.
• The use of dexamethasone also was associated with a reduction in the incidence of postoperative vomiting (RR, 0.32; 95% CI, 0.21-0.49) and need for antiemetics within 24 hours of surgery (RR, 0.42; 95% CI, 0.25-0.69).

IN PRACTICE:

“Our study revealed a beneficial opioid-sparing effect of dexamethasone in pediatric tonsillectomy,” the authors of the study wrote.

SOURCE:

The study was led by Naoko Niimi, MD, of the Department of Anesthesia and Pain Medicine at The Hospital for Sick Children in Toronto, Ontario, Canada, and was published online on August 27, 2024, in the Canadian Journal of Anesthesia.

LIMITATIONS:

Significant heterogeneity was observed in the meta-analysis of the primary outcome. The variability in administered dexamethasone doses across trials is also a major limitation. Moreover, the sample size in the included studies was not sufficient to examine postoperative hemorrhage.

DISCLOSURES:

This study was supported by the POS Summer Studentship Program, Hospital for Sick Children 2023. The authors declared no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.