A randomized clinical trial has found that a postoperative course of oral dexamethasone was associated with a modest reduction in pain following pediatric adenotonsillectomy, along with a substantial reduction in opioid prescriptions. Importantly, dexamethasone did not increase postoperative complications, supporting its use as a safe analgesic adjunct within a structured postoperative pain-management regimen. The study was published in JAMA Otolaryngology–Head & Neck Surgery by Amber D. and colleagues.
In order to examine the effects of an extended period of corticosteroid administration after surgery, researchers developed a parallel group, quadruple blind randomized controlled study. Patients aged 3 to 17 years undergoing adenotonsillectomy were recruited from August 2021 to May 2023. Pain assessments were made during 14 days post-surgery, and any adverse events occurred throughout the 5 to 9-week follow up period.
The final data set analyses were done from October 2023 to May 2026. Altogether, 763 children were screened for participation and a total of 209 patients (median age 7.1 years [IQR, 5.8 years]; 99 girls [47.4%] and 110 boys [52.6%]) were randomly assigned to get oral dexamethasone (0.5 mg/kg; maximum 20 mg) or a corresponding placebo on days 2, 4, and 6 postoperatively. Overall, 104 subjects received steroids and 105 subject’s placebo and their safety and utilization were documented. A total of 131 subjects completed pain diaries (61 steroid arm and 70 placebo arm).
Key findings:
- Of 763 children screened, 209 participants (median [interquartile range, IQR] age, 7.1 [5.8] years; 99 females [47.4%] and 110 males [52.6%]) contributed to the analysis of adverse events and health care utilization (104 and 105 allocated to steroid and placebo arms, respectively).
- Of these 209 children, 131 (61 in the steroid arm and 70 in the placebo arm) maintained pain diaries and were included in primary outcome analysis (pain).
- Mean (standard deviation, SD) pain level prior to acetaminophen or ibuprofen on days 2-8 was 0.72 (95% confidence interval, CI, 0-1.44) lower in the dexamethasone group (4.12 [2.00]) in comparison to the placebo group (4.84 [2.15]).
- The dexamethasone group in comparison to the placebo group reported lower pre-and post-analgesic pain on postoperative days 12-13 (mean difference, 0.96-2.37 points) as well as reduced odds of being prescribed an opioid (odds ratio [OR], 0.23; 95% CI, 0.06-0.84) and seeking emergency department treatment for pain (OR, 0.12; 95% CI, 0.003-0.91).
- Differences in readmissions, nursing calls, occurrence of post-tonsillectomy hemorrhage and return to the diet were not statistically significant.
In summary, post-operative oral dexamethasone was associated with a slight decrease in post-operative pain in children who underwent adenotonsillectomy surgery, a substantial decrease in the use of opioids, and no increase in complication rates, thus indicating the efficacy of using this medication as an adjunct for pain relief. Incorporating a straightforward, three-day protocol of an oral steroid into routine care regimens offers an easy non-opioid approach.
Reference:
Shaffer AD, Omar M, Maguire RC, et al. Postoperative Oral Dexamethasone and Pediatric Tonsillectomy Morbidity: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. Published online July 23, 2026. doi:10.1001/jamaoto.2026.1910
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