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Open Up and Say 'Ouch'

Traditional steroids may not lessen pain after tonsillectomy, study says

TUESDAY, Oct. 23, 2001 (HealthDayNews) -- The standard drug many doctors use to lessen a child's pain after a tonsillectomy may not work, a new study finds.

But it also does no harm, the researchers say.

Many physicians give a single dose of the steroid dexamethasone to children who have just had their tonsils removed, hoping it will reduce swelling and pain.

"A single dose of steroids doesn't cause complications, but we found that it has very little effect on post-operative pain," says Dr. Carla Giannoni, pediatric otolaryngologist at Baylor College of Medicine in Houston, Texas. "This shows we need to look for other answers. We can't depend on steroids to stop pain."

Reducing post-operative pain is particularly important these days because tonsillectomies are now an outpatient procedure. Kids who have a lot of pain after surgery may end up being readmitted to the hospital either for the pain or for such complications from the pain as dehydration, because it hurts too much to swallow.

Giannoni and her colleagues studied 50 tonsillectomy patients between the ages of 3 and 15. All received special pre-operative doses of pain medication, and half the group was given the steroid during the operation. The researchers then followed the patients for 10 days after the surgery to monitor their pain and the amounts of pain medication they received, including Tylenol with codeine.

Both groups reported similar amounts of pain on a scale of zero to 10. The steroid group used slightly less pain medication, but Giannoni said it was not enough to be statistically significant. Surprisingly, the steroid group took almost a day longer to return to normal activities, but again, Giannoni said the differences weren't great enough to make a statistical difference.

Results of the study were presented at a recent meeting of the American Academy of Otolaryngology.

"This study does bring up the question if this medication is worthwhile," says Dr. Mark Gerber, a pediatric otolaryngologist at Children's Memorial Hospital in Chicago, Ill., "but the answer has not been fully obtained." He points out that the study was done on a small number of children, and that the variety of post-operative pain medications could have altered the study's results.

The bottom line, he says, is that physicians are trying to find ways to make the post-operative period less painful. A single dose of steroids hasn't been shown to have any negative side effects, and other studies have shown that steroids are potentially beneficial, he says.

What To Do

To learn more about tonsillectomy, go to Dr.Koop.com.

This article from the Texas Pediatric Surgical Associates offers more detail on what to expect after a tonsillectomy.

SOURCES: Interviews with Carla Giannoni, M.D., assistant professor of medicine, pediatric otolaryngologist, Baylor College of Medicine, Houston, Texas; Mark Gerber, M.D., pediatric otolaryngologist-head and neck surgeon, Children's Memorial Hospital, and assistant professor of medicine, Northwestern University, Chicago, Ill.; abstract, Sept. 9, 2001, presentation, American Academy of Otolaryngology Head and Neck Surgery, Denver, Colo.
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