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Cukurova Med J. 2012; 37(4): 203-210

Comparison of the Effects of Intravenous and Peritonsillar Dexamethasone Plus Levopubivacaine in Children

Bilgin Dalkılınç, Ersel Güleç, Özgür Sürmelioğlu, Yasemin Güneş, Geylan Işık.

Purpose: We aimed to investigate the effects of intravenous and peritonsillar dexamethasone plus levopubivacaine on postoperative pain, bleeding, nausea and vomiting in children undergoing tonsillectomy or adenotonsillectomy.
Methods: After obtaining the approval of Ethics Committee of Çukurova University Medical Faculty Hospital and the patients were given informed consent, 60 patients of ASA (American Society of Anesthesiologist) 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. After anesthesia induction, 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 before tonsillectomy. 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 determined 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 were recorded. Postoperative bleeding were recorded at early and late periods.
Results: The hemodynamic parameters and demographic data of groups were similar. The insidance of nausea and vomiting was statistically higher in Group I compared to Group II and III. First analgesic administered time 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. At postoperative period, VAS and CHEOPS scores were lower in group II than the other groups. Bleeding or other complications did not recorded.
Conclusion: In concluded that, intravenous and peritonsillary dexamethasone prolonged the first analgesic administered time and decreased pain, nausea and vomiting compared to peritonsillar levobupivacaine alone in children undergoing tonsillectomy or adenotonsillectomy. However, dexamethasone did not increase postoperative bleeding after tonsillectomy.

Key words: Dexamethasone, Levobupivacaine, Peritonsillar infiltration, Postoperative analgesy, Postoperative nausea and vomiting, Bleeding

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