Tóm tắt
Background: Tonsillectomy in adults is associated with postoperative nausea, vomiting (PONV), pain, and delayed recovery. Dexamethasone may alleviate these complications.
Objective: To evaluate the effectiveness of a single 8 mg intravenous dose of dexamethasone administered at induction in reducing PONV, postoperative pain, and improving recovery after adult tonsillectomy.
Methods: This prospective, randomized controlled trial included 109 patients (ASA I - II, aged 16 - 60 years) undergoing elective tonsillectomy under general anesthesia. Participants were randomized to receive dexamethasone 8 mg IV (Group D, n = 55) or 0.9% NaCl (placebo, n = 54) at induction. Outcomes included PONV incidence and severity, pain scores (visual analog scale, VAS) at rest and during swallowing, time to first oral intake, and Quality of Recovery-15 (QoR-15) scores at 24 hours.
Results: PONV incidence was lower in Group D (9.1%) than in placebo (29.6%) (p < 0.05). Median VAS scores at rest and during swallowing were significantly lower in Group D at all time points (p < 0.05). Time to first oral water intake (4.9 ± 1.7 h vs. 8.0 ± 3.3 h) and food intake (15.6 ± 0.6 h vs. 19.4 ± 0.6 h) was shorter in Group D (p < 0.001). Mean QoR-15 scores were higher in Group D (128.3 ± 7.6) than in placebo (117.5 ± 9.6, p < 0.001).
Conclusion: A single 8 mg IV dose of dexamethasone at induction significantly reduces PONV and pain, accelerates oral intake, and improves QoR-15 scores after adult tonsillectomy.
| Đã xuất bản | 30-12-2025 | |
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| Số tạp chí | Tập 15 Số 6 (2025) | |
| Phân mục | Nghiên cứu | |
| DOI | 10.34071/jmp.2025.6.886 | |
| Từ khóa | postoperative nausea and vomiting, adult tonsillectomy, dexamethasone, analgesia |
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Bản quyền (c) 2025 Tạp chí Y Dược Huế
Seshamani M, Vogtmann E, Gatwood J, Gibson TB, Scanlon D. Prevalence of complications from adult tonsillectomy and impact on health care expenditures. Otolaryngol Head Neck Surg. 2014;150(4):574-81
The Australian Society of Otolaryngology Head and Neck Surgery. Guidelines for tonsillectomy. Sydney: The Australian Society of Otolaryngology Head and Neck Surgery; 2024 Jun
Lasrado G, Mahabadi N, Diaz S. Anatomy, head and neck, tonsils. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023
Randall DA, Hoffer ME. Complications of tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg. 1998;118(1):61-8
Kermode J, Walker S, Webb I. Postoperative vomiting in children. Anaesth Intensive Care. 1995;23(2):196-9
Myles PS, Shulman MA, Reilly J, Kasza J, Romero L. Measurement of quality of recovery after surgery using the 15-item quality of recovery scale: a systematic review and meta-analysis. Br J Anaesth. 2022;128(6):1029-39
Stark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15. Anesthesiology. 2013;118(6):1332-40
Gan TJ, Belani KG, Bergese SD, Chung F, Diemunsch P, Habib AS, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2020;131(2):411-48
Stewart R, Bill R, Ullah R, McConaghy P, Hall SJ. Dexamethasone reduces pain after tonsillectomy in adults. Clin Otolaryngol. 2002;27(5):321-6
Diakos EA, Gallos ID, El-Shunnar S, Clarke M, Kazi R, Mehanna H. Dexamethasone reduces pain, vomiting and overall complications following tonsillectomy in adults: a systematic review and meta-analysis of randomised controlled trials. Clin Otolaryngol. 2011;36(6):531-42
Carr MM, Williams JG, Carmichael L, Nasser JG. Effect of steroids on posttonsillectomy pain in adults. Arch Otolaryngol Head Neck Surg. 1999;125(12):1361-4
Tolska HK, Hamunen K, Takala A, Kontinen V. Systematic review of analgesics and dexamethasone for post-tonsillectomy pain in adults. Br J Anaesth.
;123(2):e397-e411
Al-Shehri AM. Steroid therapy for posttonsillectomy symptoms in adults: a randomized, placebocontrolled study. Ann Saudi Med. 2004;24(5):365-7
Aldamluji N, Burgess A, Pogatzki-Zahn E, Raeder J, Beloeil H, PROSPECT Working Group collaborators. PROSPECT guideline for tonsillectomy: systematic review and procedure-specific postoperative pain management recommendations. Anaesthesia. 2021;76(7):947-61
Klockgether-Radke A, Piorek V, Crozier T, Kettler D. Nausea and vomiting after laparoscopic surgery: a comparison of propofol and thiopentone/halothane anaesthesia. Eur J Anaesthesiol. 1996;13(1):3-9
Thimmasettaiah NB, Chandrappa RG. A prospective study to compare the effects of pre-, intra- and postoperative steroid (dexamethasone sodium phosphate) on post-tonsillectomy morbidity. J Pharmacol Pharmacother. 2012;3(3):25-8
Khafagy AH, Osman SM. Preoperative administration of dexamethasone reduces posttonsillectomy morbidities in adults. Egypt J Ear Nose Throat Allied Sci. 2013;14(2):113-7
Myles PS, Myles DB. An updated minimal clinically important difference for the QoR-15 scale. Anesthesiology. 2021;135(5):934-5
Shi Y, Sun Q, Wang Y, Chen C, Jin J, Wang W, et al. Can dexamethasone improve postoperative sleep and postoperative delirium in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy?
Protocol for a prospective, randomized, double-blind, controlled study. Trials. 2023;24(1):505
Mihara T, Ishii T, Ka K, Goto T. Effects of steroids on quality of recovery and adverse events after general anesthesia: meta-analysis and trial sequential analysis of randomized clinical trials. PLoS One. 2016;11(9):e0162961H





