Comparison of the effects of ıntravenous and peritonsillar dexamethasone plus levopubivacaine in tonsillectomies of children

Aim: We aimed to investigate the effects of intravenous and peritonsillar dexamethasone plus levopubivacaine in tonsillectomies of children over symptoms like pain, bleeding, nausea and vomiting.Material and Methods: After obtaining the approval of Ethics Committee of Çukurova University Medical Faculty Hospital and the patients were given informed consent, 60 patients of American Society of Anesthesiologist (ASA) class I- II between ages 3-12 which were planned to be undergone elective tonsillectomy or adenotonsillectomy were included.All patients were randomised and divided into 3 groups. Group I (n=20) patients received 0.4 mg/kg 0.5% levobupivacaine for each tonsil at the dose of max. 4 ml with peritonsillar infiltration after general anesthesia preoperatively. While Group II (n=20) and Group III (n=20) received levobupivacaine via the same route, Group II received i.v. (intravenous) dexamethasone 0.25 mg/kg and Group III 4 mg dexamethasone with peritonsillar infiltration additionally. All groups were administrated 1mg/kg tramadol iv as postoperative analgesic.Hemodynamic parameters were recorded after drug injections. Frequency of nausea and vomiting and analgesic requirements detected with Visual Analog Scale (VAS) and CHEOPS (Children?s Hospital of Eastern Ontario Pain Scale) at first, 10th, 20th, 30th, 45th minutes and first, 2nd, 4th, 6th and 24th hours (if not discharged) at first hour (early period) and for 24 hours (late period) or till discharge in recovery room were recorded. Postoperative bleeding history at early and late periods were asked and recorded.Results: The hemodynamic parameters and demographic data of groups were similar and statistically not significant. The rate of nausea and vomiting was statistically higher in Group I compared to Group II and III. Start time of additional analgesic was 3.15±0.88 in Group I, 4.85±1.09 in Group II and 5±1.21 in Group III and the difference was found significant (p<0.05). At postoperative period, Group II VAS was lower than that of Group I and III. No bleeding or other complications were recorded.Conclusion: Intravenous and peritonsillary dexamethasone prolonged the start time of additional anelgesic and decreased nausea and vomiting compared to peritonsillar levobupivacaine alone in tonsillectomies of children. However, no difference was found in bleeding with dexamethasone after tonsillectomy.Key words: Dexamethasone, Levobupivacaine, Peritonsillar infiltration, Postoperative analgesy, Postoperative nausea and vomiting, Bleeding