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Steroid use after pediatric tonsillectomy: A systematic review and meta-analysis
Elizabeth M Puyo1, Jillian L Chen1, Rahul Mullick1
1Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
International Journal of Pediatric Otorhinolaryngology
|October 14, 2025
Summary
Postoperative steroids may offer some pain relief and reduce nausea/vomiting in pediatric tonsillectomy patients. However, evidence is inconsistent, and steroids do not significantly impact postoperative hemorrhage rates.
Area of Science:
- Pediatric surgery
- Pharmacology
- Anesthesiology
Background:
- Codeine use for pediatric pain post-tonsillectomy is contraindicated.
- Need for alternative analgesics after adenotonsillectomy.
- Steroids are being explored as an alternative pain management strategy.
Purpose of the Study:
- To systematically review the efficacy of postoperative steroids in pediatric tonsillectomy.
- To evaluate the impact of steroids on pain, nausea, vomiting, and hemorrhage.
- To assess clinical outcomes following steroid administration in pediatric patients.
Main Methods:
- Systematic literature review of PubMed/MEDLINE, Cochrane Library, and Embase (2013-2024).
- Included randomized controlled trials, cohort, and observational studies.
- Pooled risk ratios calculated for postoperative hemorrhage using a random-effects model.
Main Results:
- Eight studies (4598 patients) met inclusion criteria, showing heterogeneity in steroid protocols.
- Three of five studies reported significant pain reduction at certain time points.
- No significant reduction in postoperative hemorrhage (RR 0.88); inconsistent results for nausea and vomiting.
Conclusions:
- Postoperative steroids may offer benefits for pain and nausea/vomiting, but evidence is limited and inconsistent.
- Steroids do not significantly reduce postoperative hemorrhage rates in pediatric tonsillectomy.
- Further research is required to establish the definitive role of steroids in recovery.
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