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Scientific Oral Presentations

Pediatric Otolaryngology

Session: Scientific Oral Presentations 1 - Pediatric Otolaryngology

Steroids for Pediatric Adenotonsillectomy Pain: A Prospective Multicenter Randomized Trial

Saturday, September 28, 2024
9:48 AM – 9:54 AM EDT
Location: MBCC, 225
Disclosure(s):
Wiktoria A. Gocal, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Amal Isaiah, MD, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Anna V. Borodianski:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Diego A. Preciado, MD, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Kevin D. Pereira, MD, MS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The primary objective was to compare postoperative pain control of two steroid regimens following pediatric adenotonsillectomy (AT). Secondary objectives assessed differences in return to normal diet and activity, snoring level, postoperative caregiver calls, and emergency room visits.

Methods: In this prospective randomized trial, healthy children aged 3-10 years undergoing AT at three academic tertiary care children’s hospitals were recruited and randomized to receive either 0.6 mg/kg dexamethasone on postoperative day 3 or prednisolone 0.5mg/kg days 1-3. Both groups continued standard weight-based regimens of acetaminophen and ibuprofen. A blinded research team member performed postoperative telephone surveys using the Wong-Baker FACES pain-rating scale. The electronic medical record was reviewed for secondary outcome metrics.

Results: A total of 119 patients were randomized (61 [51%] female, 58 [49%] male, and mean age of 69 months [95% CI, 66-74 months]), with 59 (49.6%) in the dexamethasone (‘dex’) group and 60 (50.4%) in the prednisolone (‘pred’) group. The pain score was lower in the pred group (3.97 [3.27 to 4.67]) compared to the dex group (4.3 [3.6 to 5]). Fitted random effects models showed the pred group had lower parent-reported pain scores (average difference = 1.37 [0.53 to 2.21], p = 0.001) and snoring (difference = 0.54 [0.28 to 0.79], p = 0.001). There were no significant differences in acetaminophen and ibuprofen use, return to normal diet, calls, or ER visits between the two arms.

Conclusions: The prednisolone-based regimen demonstrated superior efficacy than dexamethasone for average pain scores, but not the secondary outcomes. Caregivers may be involved with shared decision making regarding the regimen best suited to their child’s circumstances.

    Presenting Author(s)

  • Wiktoria A. Gocal, MD

    Resident
    University of Maryland
    Baltimore, MD, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Wiktoria A. Gocal, MD

    Resident
    University of Maryland
    Baltimore, MD, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Amal Isaiah, MD, PhD

    Professor of Otorhinolaryngology
    University of Maryland School of Medicine
    Glenelg, Maryland, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Anna V. Borodianski

    Research Trainee
    Children's National Medical Center
    Enola, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • MW

    Mary Elizabeth Williamson, MD

    Assistant Professor, Pediatric Otolaryngology, Baylor College of Medicine
    Baylor College of Medicine
    Magnolia, TX, United States

    Disclosure information not submitted.

  • Sonal V. Saraiya, MD

    Associate Professor
    Baylor College of Medicine
    Houston, TX, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Sonal V. Saraiya, MD

    Associate Professor
    Baylor College of Medicine
    Houston, TX, United States

    Disclosure information not submitted.

    • Co-Author(s)

  • Diego A. Preciado, MD, PhD

    Chief Division of Pediatric Otolaryngology
    Division of Pediatric Otolaryngology, Children's National Medical Center
    Washington, District of Columbia, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • Diego A. Preciado, MD, PhD

    Chief Division of Pediatric Otolaryngology
    Division of Pediatric Otolaryngology, Children's National Medical Center
    Washington, District of Columbia, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Kevin D. Pereira, MD, MS

    Professor and Director
    Department of Otorhinolaryngology – Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD USA
    Baltimore, MD, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • Kevin D. Pereira, MD, MS

    Professor and Director
    Department of Otorhinolaryngology – Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD USA
    Baltimore, MD, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.