The aim of this study is to compare the efficacy of adding paracetamol to systemic non-steroidal anti-inflammatory drugs (NSAIDs) versus adding dexamethasone as local infiltration to paracetamol on post tonsillectomy pain control.

A Prospective Randomized Controlled study. The study will be conducted at Ain Shams University hospital, Otolaryngology Department. Study period is 6 months from approval of the protocol. Study Participants will be recruited from outpatient ENT clinic, and ENT department inpatients.

Inclusion Criteria:

• Age: Between 4-10 years.

• Indications of tonsillectomy such as:

  • Recurrent acute attacks at least 7 episodes in the past year or at least 5 episodes per year for 2 years or at least 3 episodes per year for 3 years.
  • Chronic tonsillitis and hypertrophy of tonsils causing sleep apnea, difficulty in deglutition, interference in speech.

• Tonsillectomy by cold dissection only.

• American Society of Anesthesiologists (ASA) classification 1,2 (Normal Health, Mild systematic disease).

Exclusion Criteria:

• Patients with age less than 4 and more than 10 years.
• Indications of tonsillectomy other than chronic tonsillitis such as lymphoma.
• Patients on chronic steroid therapy
• Hemoglobin level less than 10 gm/dL
• Presence of acute infection in the upper respiratory tract, acute tonsillitis
• American Society of Anesthesiologists (ASA) classification ASA 3,4 (Severe systematic disease such as uncontrolled Diabetes, cardiac disease, liver or kidney disease, life threating medical conditions)
• Regular use of analgesics within a week of surgery.