The Effect of Dexamethasone in Reducing Propofol Injection Pain in 6 to 13-Year-Old Children Undergoing Adenotonsillectomy Surgery: A Double-Blind Clinical Trial

Introduction: Propofol is a popular intravenous anesthetic and a quick inducer of anesthesia with quick recovery. However, its downside lies with pain and discomfort during intravenous injections when injected in small blood vessels in the back of the hand, which prevails in 85% of children. This study investigates the effect of Dexamethasone in reducing propofol injection pain in children. Methods: In this double-blind clinical trial, 50 children aged from 6 to 13 years undergoing elective Adenotonsillectomy in Birjand-based Valiasr Hospital were randomly assigned into case and control groups. Intravenouscannulation was performed with intravenous cannula No. 22 on hands of all participants. Under similar conditions, 0.2 mg (oral) Midazolam as premedication and 20 ml of juice were administered for all the patients two hours before surgery. The same volume of Dexamethasone and normal saline (0.15 mg/Kg) was injected in the case and control groups, respectively. Immediately after, 20% of anesthesia induction dose of propofol (1%) was injected on all patients following which injection pain severity was measured using the Face Pain Scale (FPS) on a scale from 0 to 10. The remaining doses of propofol, Atracurium, and Fentanyl were subsequently injected whereby the anesthesia process was completed. The collected data were analyzed in SPSS-17 using t-test, Mann-Whitney, Fisher, and McNemar’s tests. The significance level was set at P<0.05. Results: Half of the participants were female. Pain severity rates were 4.32±4.89 and 6.48±1.76 in case and control groups, respectively. The results showed that pain severity was significantly greater in the controls than the cases. Heart rate increased in both groups after intervention (p <0.001). In terms of drug injection complication, three cases were reported in the control group, while there was only one patient in the cases with a significant difference between the groups according to Fisher and McNemar tests. Conclusions: Dexamethasone can be used as an effective and routine drug in the operating room to reduce propofol injection pain in children before the induction dose of propofol, hence increased satisfaction of children from anesthesia.