***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Corticosteroids are commonly given to children undergoing tonsillectomy to reduce postoperative nausea and vomiting ; however , they might increase the risk of perioperative and postoperative hemorrhage . OBJECTIVE To determine the effect of dexamethasone on bleeding following tonsillectomy in children . DESIGN , SETTING , AND PATIENTS A multicenter , prospect i ve , r and omized , double-blind , placebo-controlled study at 2 tertiary medical centers of 314 children aged 3 to 18 years undergoing tonsillectomy without a history of bleeding disorder or recent corticosteroid medication use and conducted between July 15 , 2010 , and December 20 , 2011 , with 14-day follow-up . We tested the hypothesis that dexamethasone would not result in 5 % more bleeding events than placebo using a noninferiority statistical design . INTERVENTION A single perioperative dose of dexamethasone ( 0.5 mg/kg ; maximum dose , 20 mg ) , with an equivalent volume of 0.9 % saline administered to the placebo group . MAIN OUTCOME MEASURES Rate and severity of posttonsillectomy hemorrhage in the 14-day postoperative period using a bleeding severity scale ( level I , self-reported or parent-reported postoperative bleeding ; level II , required inpatient admission for postoperative bleeding ; or level III , required reoperation to control postoperative bleeding ) . RESULTS One hundred fifty-seven children ( median [ interquartile range ] age , 6 [ 4 - 8 ] years ) were r and omized into each study group , with 17 patients ( 10.8 % ) in the dexamethasone group and 13 patients ( 8.2 % ) in the placebo group reporting bleeding events . In an intention-to-treat analysis , the rates of level I bleeding were 7.0 % ( n = 11 ) in the dexamethasone group and 4.5 % ( n = 7 ) in the placebo group ( difference , 2.6 % ; upper limit 97.5 % CI , 7.7 % ; P for noninferiority = .17 ) ; rates of level II bleeding were 1.9 % ( n = 3 ) and 3.2 % ( n = 5 ) , respectively ( difference , -1.3 % ; upper limit 97.5 % CI , 2.2 % ; P for noninferiority < .001 ) ; and rates of level III bleeding were 1.9 % ( n = 3 ) and 0.6 % ( n = 1 ) , respectively ( difference , 1.3 % ; upper limit 97.5 % CI , 3.8 % ; P for noninferiority = .002 ) . CONCLUSIONS Perioperative dexamethasone administered during pediatric tonsillectomy was not associated with excessive , clinical ly significant level II or III bleeding events based on not having crossed the noninferior threshold of 5 % . Increased subjective ( level I ) bleeding events caused by dexamethasone could not be excluded because the noninferiority threshold was crossed . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01415583 OBJECTIVE To determine the effect of preoperative dexamethasone sodium phosphate administration on posttonsillectomy morbidity for electrocautery ( " hot " ) and sharp ( " cold " ) dissection techniques . DESIGN Prospect i ve , r and omized , double-blind study . SETTING University pediatric hospital and county teaching hospital . Subjects A total of 219 children , aged 9 months to 12 years , undergoing tonsillectomy .  Intervention Participants who underwent tonsillectomy  were r and omly assigned to receive either intravenous dexamethasone sodium phosphate ( 1 mg/kg ) or placebo . OUTCOME MEASURES Pain scores , oral intake , and emesis on postoperative day ( POD ) 1 . RESULTS A total of 106 subjects ( 62 undergoing hot and 44 cold tonsillectomies ) received preoperative steroids , and 113 ( 56 hot and 57 cold tonsillectomies ) received placebo . On POD 1 , pain scores reported by patients ( P = .02 ) , parents ( P = .002 ) , and physicians ( P<.001 ) were significantly lower in subjects receiving steroids than in those receiving placebo .  Emesis was reduced from a mean of 2.1 ( placebo group ) to 1.2 episodes ( steroid group ) ( P = .02 ) . Oral intake improved from 24.5 % of normal diet ( placebo ) to 31.7 % ( steroid group ) ( P = .004 ) . When all 4 groups were compared ( cold placebo , cold steroid , hot placebo , and hot steroid ) , pain scores reported by physicians and parents were significantly lower in the cold steroid group than in the other groups . CONCLUSIONS Perioperative dexamethasone use reduces posttonsillectomy morbidity in pediatric patients in the early postoperative period after hot or cold tonsillectomy . The combination of steroid and cold dissection technique provided the greatest advantage in reducing posttonsillectomy subjective pain levels OBJECTIVE To evaluate the effects of a single pre-operative dose of dexamethasone with the frequency of postoperative vomiting and severity of throat pain in children undergoing electrocautery tonsillectomy under st and ard general anaesthesia . STUDY DESIGN R and omised controlled trial . PLACE AND DURATION OF STUDY ENT Department , Combined Military Hospital , Kharian , from January to December 2010 . METHODOLOGY Children of either gender aged between 4 - 12 years , undergoing tonsillectomy  were divided into two groups of 50 each . One group was selected to receive dexamethasone 0.5 mg/kg ( maximum of 8 mg ) ; the second group was given equivalent volume of saline , pre-operatively . The frequency of early and late vomiting was assessed postextubation . Mean time of first oral intake in minutes after extubation and mean score of postoperative throat pain were compared in both groups . Severity of throat pain was monitored by Visual Analogue Scale ( VAS ) score 0 - 10 after 4,8,12 and 24 hours of extubation . RESULTS Dexamethasone group showed significantly less postoperative early vomiting ( 12 % , n = 6 ) as compared to placebo ( 30 % , n = 15 ) group ( p < 0.05 ) . The mean time of first oral intake was earlier in the dexamethasone group ( 4 hours and 16 minutes postextubation ) , while in saline group it was 5 hours and 20 minutes ( p < 0.001 ) . Pain score was also significantly lower and swallowing was less painful in patients after 4,8,12 and 24 hours in dexamethasone group . Pain score on the average was 0.8 - 1.2 factors less in dexamethasone group than in saline group in first 24 hours on a VAS score of 1 -10 . CONCLUSION Pre-operative intravenous dexamethasone reduced postoperative vomiting and pain significantly in children undergoing electrocautery tonsillectomy Edema contributes substantially to the postoperative discomfort and morbidity of adenotonsillectomy .  In a double-blind study , 58 children undergoing adenotonsillectomy were given a single intraoperative dose of either dexamethasone or saline . The steroid markedly affected the postoperative course in the first day after surgery . According to parental reports , the percentage of patients vomiting was reduced from 48 to 4 % . Severe throat pain was reported in 57 % of controls and only 20 % of dexamethasone patients . Twice as many steroid patients as controls tolerated some soft food on the first postoperative day . It appears that dexamethasone can greatly improve patient diet and comfort after adenotonsillectomy OBJECTIVE To determine whether a single intraoperative dose of intravenous dexamethasone has an effect on  pain after tonsillectomy . DESIGN Double-blinded r and omized controlled clinical trial . SUBJECTS Thirty-four consecutive nonpediatric patients presenting for tonsillectomy . INTERVENTION Patients scheduled for electrocautery tonsillectomy  were r and omized to receive either intravenous dexamethasone or placebo during surgery . Pain was measured twice daily for 10 days by means of a visual analog scale . RESULTS There were no statistically significant differences between the groups , but the dexamethasone group had a trend to report less pain over the first several days . The dexamethasone group received less analgesic in the recovery room , but there were no differences between the groups in the 10 days afterward . CONCLUSIONS There is evidence that a single dose of dexamethasone reduces  pain after tonsillectomy to a small degree . A single dose was not associated with adverse effects , so the risk-benefit ratio may be favorable for this practice Objective : The aim of the study is to evaluate the efficacy of peritonsillar infiltration of a levobupivacaine hydrochloride and dexamethasone combination for post-tonsillectomy pain in adult patients . Methods : A total of 40 patients were included in this double-blind , r and omized , and placebo-controlled study . The patients were equally r and omized into 2 groups by means of sealed envelopes . The study group ( SG ) received peritonsillar levobupivacaine hydrochloride and dexamethasone infiltration and the control group ( CG ) received peritonsillar saline infiltration .  Pain scores at the second , fourth , eighth , 12th , 16th , and 24th hours and the second to seventh days after operation were recorded by the patients in each group using a visual analog scale . Duration of surgery and the total amount of blood loss during the surgery were also recorded for each patient . Results : All pain scores in the SG were lower than those in the CG ; however , the difference was significant at the second , 12th , and 16th hours , and the second and third day ( P < 0.05 ) . Postoperative morbidity parameters , including otalgia , nausea , vomiting , fever , halitosis , and bleeding were similar between the 2 groups . Total amount of analgesic consumption in the SG was significantly lower than in the CG on each day of the week after tonsillectomy . Conclusions : Peritonsillar infiltration of a levobupivacaine hydrochloride and dexamethasone combination may provide pain reduction and decrease analgesic consumption in the postoperative period after adult tonsillectomy OBJECTIVE To assess the effect of a course of intravenous dexamethasone on  pain after tonsillectomy . METHOD Sixty patients who underwent tonsillectomy or adenoidectomy and tonsillectomy were r and omly divided into experimental group and control group . Postoperatively , 30 patients in experimental group received anti-inflammatory drug and dexamethasone for 4 days , and the other 30 patients in control group received anti-inflammatory drug and placebo . Degree of postoperative pain was measured with visual analogue scale in the patients more than 12-year-old and with Wong-Baker faces pain scale in the patients less than or equal to 12-year-old . The measurement was made twice daily for 5 days . RESULT During the postoperative period , the scale value was decreasing every day in the all patients . But the value in experimental group was less than that in control group , and the difference was statistically significant ( P<0.05 ) . CONCLUSION Dexamethasone given in this regime reduces postoperative pain and odynophagia after tonsillectomy Tonsillectomy is one of the most frequently performed ambulatory surgical procedures in children ( Litman et al. in Anesth Analg 78:478–481 , 1994 ) . Several techniques have been described for alleviation of pain ( Ginstrom et al. in Acta Otolaryngol 125:972–975 , 2005 ) . the objective of this study determination of the postoperative analgesic efficacy of the pre-surgical intravenous administration of dexamethasone together with glossopharyngeal nerve block ( GNB ) in children undergoing tonsillectomy .  Prospect i ve double blind r and omized control study using both pre-operative injection of 0.5 mg/kg dexamethasone iv and 3 ml of 0.5 % bupivacaine local injection for bilateral glossopharyngeal nerve block . Patients in group B had significantly less visual analogue scale values , longer absolute analgesia time , lesser swallowing difficulty and they were discharged earlier from the hospital when compared to patients in both groups D and G. Using both pre-operative dexamethasone IV injection with GNB has reduced postoperative pain and morbidity to a great extent than using either alone A prospect i ve , r and omized , double-blinded , placebo-controlled clinical trial was conducted in 41 patients evaluating the effect of a single preoperative dose of intravenous dexamethasone on postoperative vomiting and pain in children undergoing elective tonsillectomy .  Dexamethasone was found to significantly reduce the incidence of vomiting in the first 24 hours postoperatively ( P=0.02 ) , the time to first intake of solids ( P=0.001 ) , the need to administer a rescue antiemetic  ( P=0.005 ) and intravenous fluid therapy requirements ( P=0.006 ) in the post 
    Output:
    
IV and local steroids statistically significant decrease immediate post-operative pain severity .
Local steroids had extended effect in reducing pain scores on the first day after tonsillectomy .
However , the clinical significance of pain relief had to be concerned due to decreasing VAS only about 1 out of 10 .
Adding oral steroids to IV steroids gave no difference in effect from IV steroids alone .
Steroids have no statistically significant effect in reducing pain severity after a 1-day period .
Conclusion Intravenous steroids statistically significantly decrease post-tonsillectomy nausea/vomiting , and immediate pain scores ( < 24 h ) in children and adults .
There is evidence in only children that local steroids statistically significantly decreases post-tonsillectomy nausea/vomiting , and pain scores during the 0-h to 1-day period