Impact of Dexamethasone on Cytokine-Mediated Inflammation and Pain Relief in Pediatric Tonsillectomy: A Randomized Controlled Trial

Tonsillectomy is a common surgical procedure performed in pediatric patients, often resulting in postoperative pain. This study was conducted to assess the role of intraoperative dexamethasone in relieving pain after adenotonsillectomy, potentially through modulation of proinflammatory cytokine levels, particularly TNF-α and IL-۶. A prospective randomized controlled trial was conducted at El-Zahraa Hospital, Al-Azhar University Faculty of Medicine for girls, from January ۲۰۲۳ to October ۲۰۲۳. The total sample size of the children in this study was ۱۲۰, with ages ranging from ۳ to ۷ years. Sixty children were enrolled and randomly allocated into two groups: a dexamethasone group and a placebo group. The dexamethasone group received a single dose of intravenous dexamethasone during anesthesia induction. Serum inflammatory biomarkers interleukin-۶ (IL-۶) and tumor necrosis factor-α (TNF-α) were measured in blood samples in both groups, taken at preoperative day ۰ and ۷ days postoperatively, and analyzed by using Enzyme-linked immunosorbent assay (ELISA). Patients were instructed to complete the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) questionnaire from the day of surgery until the seventh postoperative day. Data were analyzed statistically using SPSS version ۲۰. Intravenous dexamethasone significantly decreased serum levels of both IL-۶ and TNF-α and also significantly decreased postoperative pain scores after adenotonsillectomy (p ˂ ۰.۰۵). On the third and seventh days after surgery, ۷۶.۷% of dexamethasone group participants had pain scores of ۶ or higher on the CHEOPS scale compared to ۱۰۰% of placebo group participants (p ˂ ۰.۰۵). Intravenous dexamethasone is beneficial in reducing post-adenotonsillectomy discomfort. Dexamethasone's pain-relieving benefits may be due to its ability to modulate cytokine production and reduce inflammation. This research emphasizes the efficacy of dexamethasone as an additional treatment during tonsillectomy operations, providing better pain control and patient comfort.

کلیدواژه ها:

Adenotonsillectomy Pain ، The Children' s Hospital of Eastern Ontario Pain Scale (CHEOPS) ، dexamethasone ، Cytokines