Oral dexamethasone after children's tonsillectomy cut opioid prescriptions, with a modest pain effect

Design

Single-centre, quadruple-blinded randomised trial

Population

209 children aged 3–17 having adenotonsillectomy (131 in pain analysis)

Primary outcome

Mean pain score on postoperative days 2–8

Effect

0.72 points lower (95% CI 0 to 1.44); opioid prescription OR 0.23 (0.06–0.84)

A single-centre, quadruple-blinded trial randomised 209 children aged 3 to 17 having adenotonsillectomy to oral dexamethasone 0.5 mg/kg (maximum 20 mg) or placebo on postoperative days 2, 4 and 6.

Only 131 children returned pain diaries for the primary outcome. Mean pain on days 2 to 8 was 0.72 points lower with dexamethasone on a 0–10 scale, but the confidence interval ran from 0 to 1.44, and pain before the first dose already differed between groups, so the authors could not draw a firm conclusion. Pain was lower on days 12 and 13. Children given dexamethasone had much lower odds of an opioid prescription (OR 0.23) and of an emergency visit for pain (OR 0.12), though both estimates were imprecise. Bleeding, readmissions and return to diet did not differ meaningfully.

The trial supports dexamethasone as a cheap analgesic adjunct with no signal of increased haemorrhage, though it was too small to exclude a small increase; the size of the pain benefit is also uncertain, and a third of children did not contribute to the primary outcome. It was published in September 2026.

• Consider oral dexamethasone 0.5 mg/kg (maximum 20 mg) on days 2, 4 and 6 after paediatric adenotonsillectomy as an analgesic adjunct.
• Expect a modest effect on day-to-day pain; the clearer benefit was fewer opioid prescriptions and emergency visits.
• No increase in post-tonsillectomy haemorrhage was seen in this trial, though it was too small to exclude a small increase.
• Continue scheduled paracetamol and ibuprofen as the analgesic base.
• Give parents clear written guidance on pain around days 5 to 10, when it often peaks.

Why it matters

A cheap, familiar drug may keep children off opioids after one of the most painful operations in ENT.

Don't overread it

The primary pain result was inconclusive, and a third of children did not return pain diaries.

The statistics, in plain English

A mean difference of 0.72 points with a 95% CI of 0 to 1.44 means the true effect could be anywhere from nothing to about 1.4 points. The odds ratio for opioid prescription (0.23, 95% CI 0.06–0.84) suggests a large effect, but the wide interval shows it rests on few events.

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