ROLE OF PERIOPERATIVE DEXAMETHASONE IN POSTTONSILLECTOMY-ORIGINAL ARTICLE

Abstract

Tonsillectomy is one of the most commonly performed surgical procedures in otolaryngology carried out in children presented with increased risk of certain conditions such as sore throat, referred otalgia, and poor oral feeds. Worst pain after tonsillectomy with any method is the most common cause that lowers the quality of life and prolonged hospital stay. It also affects eating, therefore increasing morbidity and posing a challenge for surgeons and anesthesiologists. Post-tonsillectomy pain is probably the result of constrictor muscle spasms caused by inflammation. The other probable cause would be the exposed nerve endings in the tonsillar
fossae after the removal of the tonsil. There has been a variable practice globally about the use of corticosteroids in the reduction of post-tonsillectomy morbidity and our country to date has no existing standard protocol for perioperative care during tonsillectomy and this created a call for designing this present study. Dexamethasone has been used for postoperative nausea, vomiting and inflammation. Prostaglandins are important mediators of pain. Steroids inhibit phospholipase thus lowering the products of cyclooxygenase & lipoxygenase pathways which elevate pain3. They also inhibit cytokine gene expression and release of pro-inflammatory mediators, bradykinin from the damaged nerve endings, all of which also worsen pain. Injection Dexamethasone has an anti-inflammatory effect and has also proven its analgesic activity in other surgical specialities. The analgesic effect of steroids has been observed by Asboe et al for hemorrhoidectomy surgery.