Steroids for Pediatric Adenotonsillectomy Pain-A Prospective Multicenter Randomized Trial.

Objective: To compare postoperative caregiver-reported pain control of two steroid regimens following pediatric adenotonsillectomy. Secondary objectives assessed differences in analgesic use, return to normal diet, caregiver calls, adverse effects, and emergency room (ER) visits.

Methods: Prospective randomized pragmatic trial. Methods: Three academic tertiary care children's hospitals. Methods: Healthy children aged 3 to 10 undergoing adenotonsillectomy were recruited and randomly assigned to receive either 0.6 mg/kg dexamethasone on postoperative day 3 or prednisolone 0.5 mg/kg days 1 to 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. Secondary outcomes were reviewed using a combination of a telephone survey and electronic health record review.

Results: A total of 119 patients were randomly assigned (61 [51%] female, 58 [49%] male, and mean age of 5.8 years (95% CI, 5.5-6.2), with 59 (49.6%) in the dexamethasone group and 60 (50.4%) in the prednisolone group. The pain score was lower in the prednisolone group (4.0 [3.7-4.3]) in the univariate model. However adjustment for covariates and random effects mitigated this difference (b = 0.00; 95% CI, -0.52 to 0.52; P = .99). There were no significant differences in analgesic use, return to normal diet, calls, adverse effects, or ER visits. There were no subgroup effects related to surgical technique.

Conclusions: Prednisolone and dexamethasone-based regimens show comparable efficacy for pain scores, return to diet and resumption of activities with no reported adverse events. Shared decision-making should involve caregivers to select the regimen best suited for their child's circumstances.