Tehran University Medical Journal

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Background: Tonsillectomy is the second most common pediatric surgery. Despite improvements in anesthetic and surgical technique, post-tonsillectomy pain continues to be a significant clinical concern for the patient, family, and physician. Young patients undergoing tonsillectomy experience postoperative pain and vomiting resulting in delays in oral feeding and in discharge from the hospital. Reduction of these side effects will lead to the improved quality of postoperative care. This study was performed to compare the efficacies of local Bupivacaine and intravenous Dexamethasone with that of a placebo on post-tonsillectomy pain and vomiting.
Methods: This clinical trial included 120 ASA I children, aged 3-15 years, undergoing tonsillectomy. The patients were randomly categorized into three groups: 1- local infiltration of 2 ml normal saline into the tonsillar pillar as a placebo 2- IV Dexamethasone (0.5 mg/kg, with a maximum of 16 mg) 3- local infiltration of 2 ml 0.5% Bupivacaine into the tonsillar pillar. After the operation, patients were observed regarding vomiting and pain at 0.5, 4, 24, 120 hours postextubation.
Results: Of 120 patients, 70 were male and 50 were female. The mean age of patients was 8.4 years. Three patients were missed in follow up. The questionnaire was completed for 117 patients. The mean duration of operation was longest in the placebo group (55 minutes) and shortest in Dexamethasone group (50 minutes). We noticed significant reduction in postoperative pain only in the Bupivacaine group and at the fourth postoperative hour. In the Dexamethasone group, during the first 24 hours, we could not statistically analyze the effect on vomiting. Since Bupivacaine and Dexamethasone reduce postoperative pain and vomiting, respectively, and are safe, cost-effective and available, we recommend using these drugs for tonsillectomy patients.
Conclusion: Considering the greater efficacy of Dexamethasone in the reduction of vomiting and that of Bupivacaine in pain reduction in other studies, we recommend further study to assess the use of these two drugs together.

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Background: In rhinoplasty, periorbital edema and ecchymosis is due to soft tissue trauma and small vessel injury with subsequent exudation and bleeding. The main purpose of this study is to determine the effect of dexamethasone in reducing periorbital edema and ecchymosis and intraoperative bleeding in rhinoplasty patients.

Methods: This double-blind study included 90 patients who underwent rhinoplasty from October 2004 to March 2005. In group A, 8 mg of intravenous dexamethasone was administered only preoperatively. In group B, 8 mg of dexamethasone was administered preoperatively and continued every 8 hours postoperatively. Group C, the control group, received no dexamethasone.

Results: The degree of upper lid edema in groups A and B was significantly less than that of group C. During the first and second day the severity of upper lid edema in group B was less than that of group A, but the difference was not significant. The degree of lower lid edema during the first and second days in groups A and B was significantly less than that of group C, although it was identical in all groups during the fifth and seventh days. The degree of upper lid ecchymosis during the first and fifth days in group C was significantly more than that of groups A and B, but it was similar on the seventh day in all groups. The degree of lower lid ecchymosis on the first day in groups A and B was significantly less than that of group C however, it was similar in all groups during the second, fifth and seventh days. The volume of intraoperative bleeding in the three groups was similar. The mean period of recovery (12 days) was comparable in all groups.

Conclusions: Dexamethasone administration leads to the reduction of upper lid edema, ecchymosis and lower lid edema during the first and second postoperative days, and reduction of lower lid ecchymosis on the first postoperative day.