Randomized, Controlled Trial of Post-operative Steroids and Pain Control After Tonsillectomy

The study will be performed prospectively and in a randomized, double-blinded, placebo controlled manner. Patients meeting inclusion and not violating exclusion criteria will be randomized to either receive a single oral steroid dose or a single placebo dose on the third day after surgery. All study patients will otherwise receive the standard of care in all other aspects of their treatment. That is, the surgery itself, the post-operative pain control strategies/medication, patient instructions, and follow up will not differ between the two groups. The pediatric otolaryngology department has standardized post-operative pain control (a specific order set is used) which will ensure no differences between different providers.

Oral dexamethasone is the study drug and will be given in 0.5mg/kg dosage and the route is 3mg capsules in increments of one capsule. Doses are calculated by weight and rounded up to the nearest 3mg up to a maximum of 12mg (4 capsules). Parents are instructed to give the medication on the morning of the third day after surgery. Parents can either have the child swallow the capsule or, if the child does not tolerate this, open the capsule and mix the contents into food the consistency of applesauce, then administer. A placebo will also be designed in the same route as the oral dexamethasone. Both the placebo and oral dexamethasone capsules will be purchased from by Tidewater Pharmacy and Compounding, an accredited pharmacy located in Mt. Pleasant, South Carolina12. Weight based instructions will be included with the study materials. During distribution, the member of the study team delivering the study materials will confirm the dosing with the parents.

Study materials will be assembled and randomized by the project lead, and will include a small container with four capsules of either placebo or oral dexamethasone. All study materials will be assigned a unique record number between 001 and 150. The materials will be block-randomized in groups of 30 to either contain placebo or oral dexamethasone, and linked to the record number in a secured file held by the project lead. This file will be inaccessible to any but the project lead during data collection. The study materials with the drug or placebo will be kept in a temperature controlled locked cabinet at the study site, MUSC Children's Health R. Keith Summey Medical Pavilion.

Immediately following the procedure in the operating room, once lack of exclusion criteria has been confirmed by the operating surgeon, patients will be assigned a subject record number in numerical order. This record number will be recorded, linked to the patient's medical record number, and kept in a secure file separate from the randomization list. The randomization process will be blinded from the parents, subjects, study coordinator, and operating surgeon. The subject's parents will then receive study materials that correspond to their unique record number, which will include either four 3mg dexamethasone capsules or four placebo capsules. Weight based instructions will be included with this dosing, and providers and/or research team members will go over these instructions with parents again when giving the study materials.

After randomization, the operating surgeon will complete a questionnaire to document details of the surgery, including: who performed the surgery, intracapsular versus extracapsular tonsillectomy, estimated blood loss, and use of suction cautery on the tonsillar bed. This will be collected by the study coordinator and linked to the patient record number.