A meta-analysis of dexamethasone use with tonsillectomy

OBJECTIVE: To determine the quantitative impact of intravenous dexamethason e on recovery after tonsillectomy using established principles for metaanal ysis. STUDY DESIGN/SETTING: Double-blind randomized-control trials in which subje cts were treated identically except for the presence or absence of perioper ative intravenous dexamethasone. Six articles met inclusion criteria. Two i nvestigators extracted data regarding postoperative emesis and return to a soft/regular diet. RESULTS: Pooled analysis using a random effects model revealed a 27% decrea se (P < 0.00001) in postoperative emesis attributable to dexamethasone (95% CI, 12% to 42%). Dexamethasone increased the tolerance of a soft/regular d iet at 24 hours by 22% (P < 0.001), but studies were heterogenous with low precision (95% Ct, 1% to 44%). CONCLUSION: To prevent emesis in 1 child after tonsillectomy, approximately 4 children must receive perioperative dexamethasone. An additional benefit is earlier tolerance of a soft/regular diet, but low precision and heterog eneity among studies preclude definitive conclusions. SIGNIFICANCE: Perioperative dexamethasone administration had a positive imp act on recovery from tonsillectomy.