Intraoperative Dexamethasone Single Dose and Risk of Postoperative Haemorrhage in Tonsillectomy Patients

Introduction: Several meta-analyses investigating morbidity following tonsillectomy have demonstrated that under controlled conditions a single intravenous dose of Dexamethasone (DX) is an effective, safe and inexpensive method of reducing the incidence of postoperative nausea and vomiting (PONV) following tonsillectomy in children1-5. Unfortunately, there is substantial variability across these studies with respect to design, surgical technique, method of acquiring hemostasis and age of patients. We undertook the study to find out the effectiveness of intraoperative single IV dose of dexamethasone on the risk of postoperative haemorrhage in tonsillectomy patients. Objective: To assess whether dexamethasone dose-dependently reduces or increases the risk of postoperative haemorrhage in tonsillectomy patients. Methods: This study was conducted with 200 patients who underwent tonsillectomy. Patients were divided into four groups of 50, where one group (n=50) received intraoperative dexamethasone of 0.05mg/kg, second group (n=50) received intraoperative dexamethasone of 0.15mg/kg, third group (n=50) received intraoperative dexamethasone of 0.5mg/kg and the fourth group (n=50) were given placebo injection Normal Saline. Bleeding episodes of all the groups were recorded in first 7 days following surgery. Children were randomly assigned to receive dexamethasone injectioin (0.05, 0.15 or 0.5mg/kg) and placebo intravenous Normal saline after induction of anaesthesia. Acetaminophen-codeine and ibuprofen were given as postoperative analgesics. Follow up continued until the 7th postoperative day. Results: At 24 hours, 2 of the 50 children who received placebo (4 %; 95 % CI, 0.5 %- 13 %), 6 of 50 (12 %; 95 % CI, 4 %-23 %) who received dexamethasone, 0.05mg/kg, 2 of 50 (4 %; 95 % CI, 0.5 %-13 %) who received dexamethasone, 0.15 mg/kg, and 12 of 50 (24 %; 95 % CI, 13 %-38 %) who received dexamethasone, 0.5 mg/kg, had at least 1 bleeding episode (P=.003). The largest dose of dexamethasone 0.5mg/kg was associated with the highest risk of bleeding (24 %; 95 % CI, 13 %-38 %). Children who received dexamethasone received significantly less ibuprofen. There were 26 postoperative bleeding episodes in 22 children. Dexamethasone 0.5mg/kg was associated with the highest bleeding risk. Conclusion: A single dose of intraoperative intravenous dexamethasone was significantly associated with increased risk of postoperative haemorrhage in tonsillectomy patients.