Prevention of POV After Paediatric Tonsillectomy

Vomiting After Tonsillectomy in Children: A Comparison of Dexamethasone and Acupuncture

Tonsillectomy is one of the most frequently performed surgical procedures in children. It remains associated with a high morbidity related to postoperative vomiting (POV), pain, risk of bleeding, and dehydration due to impaired oral intake. Current medications for POV have limited efficacy and may even be associated with potential side-effects. Non-pharmacological techniques such as acupuncture has been investigated as alternatives to antiemetics and as additional treatment modalities for POV.

Postoperative vomiting (POV) is one of the most common complication in children undergoing tonsillectomy. Its incidence is between 62% and 73% when no prophylactic antiemetic is given. Because of Limited efficacy and side effects with antiemetics, many alternative treatment had been used. Acupuncture is simple, inexpensive, and noninvasive with minimal side effects. The objective of this study is to compare two prophylactic antiemetic treatments :

• Dexamethasone (0.15 mg/kg) immediately after induction of anaesthesia
• Acupuncture treatment (immediately after induction of anaesthesia and for approximately 20 minutes)

Inclusion Criteria:

• children aged 2-8 y.
• children ASA 1-2
• tonsillectomy with or without adenoidectomy

Exclusion Criteria:

• American Society of Anesthesiologists grade greater than or equal to III (patient with severe systemic disease)
• intravenous induction
• contraindication to steroids
• Rash or local infection over an acupuncture point
• administration of steroids in the 24 hours before the surgery
• Use of medication with antiemetic effect within the 24 hours before surgery
• Gastric or intestinal diseases
• refusal of parents