This quadruple-blinded RCT evaluated whether postoperative oral dexamethasone (0.5 mg/kg, max 20 mg) on days 2, 4, and 6 after surgery reduces pain and morbidity in children aged 3–17 undergoing adenotonsillectomy, with 14-day pain follow-up and 5–9 weeks for adverse events.
Dexamethasone reduced mean pre-analgesic pain scores by 0.72 points (days 2–8; 4.12 vs. 4.84) with wide CIs preventing definitive conclusions, but meaningfully cut odds of opioid prescription (OR 0.23; 95% CI 0.06–0.84) and ED visits for pain (OR 0.12; 95% CI 0.003–0.91), with no increase in complications such as posttonsillectomy hemorrhage or readmission.
- High attrition in pain diary completion (131/209 completed, ~37% missing), with unequal dropout between arms (61 steroid vs. 70 placebo), risking bias in the primary outcome. - Single tertiary academic center limits generalizability. - Wide confidence intervals throughout reduce precision and interpretability of key estimates.
A short postoperative course of oral dexamethasone (days 2, 4, and 6) appears safe and may meaningfully reduce opioid prescriptions and ED pain visits after pediatric adenotonsillectomy — consider it as a standard analgesic adjunct. Reassuringly, it did not increase hemorrhage risk or other complications.
