Adjuvant therapies in children undergoing adenotonsillectomy.

Objective: To review adjuvant therapies used in children undergoing adenotonsillectomy, addressing several areas of controversy.

Study Design: Review.

Methods: Studies of perioperative injection of local anesthetic agents, postoperative use of antibiotics, perioperative use of intravenously administered steroids, and pain management in adenotonsillectomy were reviewed.

Results: Controversy exists about all adjuvant therapies discussed. Injection of local anesthetics may reduce pain and bleeding but has been associated with several serious side effects. Most patients receive antibiotics postoperatively, but no consensus exists about the agent of choice or duration of its use and there is concern about development of bacterial resistance. A meta-analysis found that children given steroids perioperatively were less likely to have an episode of emesis, but the analysis could not assess the role of steroids in pain control because of a lack of data. The effectiveness of acetaminophen alone compared with acetaminophen plus a narcotic for analgesia after adenotonsillectomy is controversial.

Conclusion: Adjuvant therapies have many possible benefits for children undergoing adenotonsillectomy, but otolaryngologists must make careful choices about these treatments.