Steroid use after pediatric tonsillectomy: A systematic review and meta-analysis.

OBJECTIVE

Codeine-containing products for postoperative pain in pediatric adenotonsillectomy were contraindicated in 2013, prompting a search for alternative analgesic methods. This systematic review examines whether postoperative steroids improve clinical outcomes - specifically pain, nausea, vomiting, and postoperative hemorrhage - in pediatric patients following tonsillectomy.

DATA SOURCES: Comprehensive literature review (MEDLINE/PubMed, Cochrane Library, Embase) of studies conducted internationally between February 20, 2013, and December 5, 2024.

METHODS

A comprehensive literature search of PubMed/MEDLINE, Cochrane Library, and Embase was conducted for studies published between February 20, 2013 and December 5, 2024. Included studies were randomized controlled trials, cohort studies, and observational studies evaluating postoperative steroid use in pediatric tonsillectomy patients with reported outcomes of pain, nausea, vomiting, or hemorrhage. Extracted data included steroid type, dosage, timing, and primary outcomes. A random-effects model was used to calculate pooled risk ratios for postoperative hemorrhage.

RESULTS

Eight studies, reporting on 4598 patients, met inclusion criteria. The studies exhibited heterogeneity in steroid type, dose, and timing. Pain outcomes varied, with three of five studies reporting significant reductions at specific postoperative time points. Pooled analysis of postoperative hemorrhage rates revealed no significant reduction (RR 0.88, 95 % CI 0.55-1.41, p = 0.60). Three studies evaluated nausea and vomiting; one reported significant reduction, while the other two showed no difference.

CONCLUSIONS

While postoperative steroids may reduce pain and possibly alleviate nausea and vomiting after pediatric tonsillectomy, current evidence is limited and inconsistent due to study heterogeneity. Steroids do not appear to significantly affect postoperative hemorrhage rates. Further research is needed to clarify their role in recovery.