Anaesth Crit Care Pain Med. 2025 Nov 21:101706. Revista: 10.1016/j.accpm.2025.101706. Online ahead of print.

BACKGROUND: Despite the available evidence for the use of non-steroidal anti-inflammatory drugs (NSAIDs) as the preferred therapeutic option for managing postoperative pain after tonsillectomy in children, many physicians still use postoperative corticosteroids as a therapeutic option in place of NSAIDS. The aim of the current meta-analysis was to explore the analgesic efficacy of oral prednisolone after tonsillectomy in children.

METHODS: The study consisted of a quantitative review of randomised controlled studies performed during paediatric tonsillectomy that examined the effect of postoperative prednisolone given during several postoperative days in comparison to placebo, on postoperative pain intensity and nausea, and vomiting. Quality of evidence was assessed using GRADE recommendations.

RESULTS: Oral prednisolone did not reduce pain intensity at postoperative day 1 (MD = -0.38 [-0.99, 0.33], I² = 84 %, p of I² < 0.002), postoperative day 3 (MD = -1.02 [-2.78, 0.75], I² = 97 %, p of I² < 0.0001) and between the postoperative days 5 and 7 (MD = -0.15 [-0.35, 0.04], I² = 84 %, p of I² < 0.001). Oral prednisolone did not reduce postoperative nausea and vomiting. The quality of evidence according to GRADE recommendations ranged from low to very low.

DISCUSSION: The current meta-analysis indicates that the administration of oral prednisolone postoperatively does not decrease postoperative pain in paediatric patients following tonsillectomy. In conclusion, the paucity of studies, the high heterogeneity of results, and the low grade of evidence mandatory to perform further studies to confirm the results of the current review.

REGISTRATION: PROSPERO database (CRD420251088747).

PubMed:41276080 | Revista:10.1016/j.accpm.2025.101706