Preoperative intravenous dexamethasone combined with glossopharyngeal nerve block: role in pediatric postoperative analgesia following tonsillectomy

  • Sherif K. MohamedEmail author
  • Abdelrady S. Ibraheem
  • Mohammed G. Abdelraheem


Tonsillectomy is one of the most frequently performed ambulatory surgical procedures in children (Litman et al. in Anesth Analg 78:478–481, 1994). Several techniques have been described for alleviation of pain (Ginstrom et al. in Acta Otolaryngol 125:972–975, 2005). the objective of this study determination of the postoperative analgesic efficacy of the pre-surgical intravenous administration of dexamethasone together with glossopharyngeal nerve block (GNB) in children undergoing tonsillectomy. Prospective double blind randomized control study using both pre-operative injection of 0.5 mg/kg dexamethasone iv and 3 ml of 0.5% bupivacaine local injection for bilateral glossopharyngeal nerve block. Patients in group B had significantly less visual analogue scale values, longer absolute analgesia time, lesser swallowing difficulty and they were discharged earlier from the hospital when compared to patients in both groups D and G. Using both pre-operative dexamethasone IV injection with GNB has reduced postoperative pain and morbidity to a great extent than using either alone.


Tonsillectomy Pain Dexamethasone Glossopharyngeal 



Informed consent was obtained from each patient and the Institutional Review Board of Ain-Shams University Hospital approved the study protocol. The researchers supported this work fund.

Conflict of interest statement

We declare that there are no claims or conflicts of interest.


  1. 1.
    Litman RS, Wu CL, Catanzaro FA (1994) Ondansetron decreases emesis after tonsillectomy in children. Anesth Analg 78:478–481PubMedCrossRefGoogle Scholar
  2. 2.
    Weimert TA, Babyak JW, Richter HJ (1990) Electrodissection tonsillectomy. Arch Otolaryngol Head Neck Surg 116:186–188PubMedGoogle Scholar
  3. 3.
    Dray A, Bevan S (1993) Inflammation and hyperalgesia/highlighting the team effort. Trends Pharmacol Sci 14:287–290PubMedCrossRefGoogle Scholar
  4. 4.
    Dray A, Urban L, Dickenson A (1994) Pharmacology of chronic pain. TIPS 15:190–197PubMedGoogle Scholar
  5. 5.
    Levine JD, Fields HL, Basbaum AI (1993) Peptides and the primary afferent nociceptor. J Neurosci 13:2273–2286PubMedGoogle Scholar
  6. 6.
    Toma AG, Blanshard J, Eynon-Lewis N, Bridger MW (1995) Posttonsillectomy pain: the first ten days. J Laryngol Otol 109:963–964PubMedCrossRefGoogle Scholar
  7. 7.
    Ozalevli M, Unlugenc H, Tuncer U, Gunes Y, Ozcengiz D (2005) Comparison of morphine and tramadol by patient-controlled analgesia for postoperative analgesia after tonsillectomy in children. Paediatr Anaesth 15:979–984PubMedCrossRefGoogle Scholar
  8. 8.
    Hanasono MM, Lalakea ML, Mikulec AA, Shepard KG, Wellis V, Messner AH (2004) Perioperative steroids in tonsillectomy using electrocautery and sharp dissection techniques. Arch Otolaryngol Head Neck Surg 130:917–921PubMedCrossRefGoogle Scholar
  9. 9.
    Valijan A (1989) Pain relief after tonsillectomy. Effect of benzydamine hydrochloride spray on postoperative pain relief after tonsillectomy. Anesthesia 44:990–991CrossRefGoogle Scholar
  10. 10.
    Ginstrom R, Silvola J, Saarnivaara L (2005) Local bupivacaineepinephrine infiltration combined with general anesthesia for adult tonsillectomy. Acta Otolaryngol 125:972–975PubMedCrossRefGoogle Scholar
  11. 11.
    Alhava E (1994) Reported adverse drug reactions and consumption of non-steroidal anti-inflammatory drugs. Pharmacol Toxicol 75(Suppl 11):37–43PubMedCrossRefGoogle Scholar
  12. 12.
    Naja MZ, El-Rajab M, Sidani H, Kabalan W, Ziade MF, Al-Tanni MA (2005) Modified infiltration technique in tonsillectomy: expanded case report of 25 children. Int J Pediatr Otorhinolaryngol 69:35–41PubMedCrossRefGoogle Scholar
  13. 13.
    Anila D. Malde1. Vinod S. Sonawane. and Sheetal R. Jagtap Effect of dexamethasone on posttonsillectomy morbidities Indian J. Anaesth. 2005; 49 (3): 202 – 207Google Scholar
  14. 14.
    Kaan MN, Odabasi O, Gezer E, Daldal A (2006) The effect of preoperative dexamethasone on early oral intake, vomiting and pain after tonsillectomy. Int J Pediatr Otorhinolaryngol 70(1):73–79PubMedCrossRefGoogle Scholar
  15. 15.
    Steward DL, Welge JA, Myer CM (2001) Do steroids reduce morbidity of tonsillectomy? Meta-analysis of randomized trials. Laryngoscope 111(10):1712–1718PubMedCrossRefGoogle Scholar
  16. 16.
    Al-Shehri AM (2008) Steroid therapy for post-tonsillectomy symptoms in adults: a randomized, placebo-controlled study. Ann Saudi Med 24(5):365–367Google Scholar
  17. 17.
    Windfuhr JP (2008) Steroids for reduction of morbidity following tonsillectomy. HNO 56(1):43–53PubMedCrossRefGoogle Scholar
  18. 18.
    El-Hakim H, Nunez D, Saleh H, MacLeod D, Gardiner Q (2000) A randomised controlled trial of the effect of regional nerve blocks on immediate post-tonsillectomy pain in adult patients. Clin Otolaryngol Allied Sci 25(5):413–417PubMedCrossRefGoogle Scholar
  19. 19.
    Kountakis Stilianos E (2000) Effectiveness of perioperative bupivacaine infiltration in tonsillectomy patients. Am J Otolaryngol 23:76–80CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Sherif K. Mohamed
    • 1
    Email author
  • Abdelrady S. Ibraheem
    • 2
  • Mohammed G. Abdelraheem
    • 2
  1. 1.ENT DepartmentAin-Shams UniversityCairoEgypt
  2. 2.Anesthesia and ICU DepartmentAssiut UniversityAsyûtEgypt

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