Wang Xiaoxue,Gao Zhengzheng,Ma Yangwei,et al.Study on the effect of prophylactic analgesia with ibuprofen injection on awakening period pain in children after tonsillectomy[J].Journal of Clinical Pediatric Surgery,,():866-871.[doi:10.3760/cma.j.cn101785-202406040-012]
Study on the effect of prophylactic analgesia with ibuprofen injection on awakening period pain in children after tonsillectomy
- Keywords:
- Tonsillectomy; Anesthesia; General; Anesthesia and Analgesia; Ibuprofen; Child
- Abstract:
- Objective To observe the effect of prophylactic use of ibuprofen injection during tonsillectomy (with or without adenoidectomy) on alleviating postoperative awakening period pain in children. Methods This study was a prospective,single-center,double-blind,randomized controlled trial.A total of 106 children,aged 3 to 9 years (57 males and 49 females),who underwent tonsillectomy (with or without adenoidectomy) under general anesthesia at Beijing Children’s Hospital,Capital Medical University,from April 2021 to September 2021,were included.The children were randomly divided into an observation group (52 cases) receiving ibuprofen injection and a control group (54 cases) not receiving ibuprofen injection,using a random number table method.A standardized anesthesia induction and total intravenous maintenance protocol was used for all patients.The observation group received an intravenous infusion of ibuprofen injection at the start of surgery,with a dose of 10 mg/kg (maximum dose of 400 mg),diluted with 0.9% sodium chloride injection,with a final concentration not exceeding 4 mg/mL,and infused over 15 minutes.Pain scores were recorded at 8 time points within 2 hours after awakening,at 15-minute intervals (labeled T1,T2,T3,T4,T5,T6,T7,T8).Pain was assessed using the FLACC score (face,legs,activity,cry,consolability score),covering five aspects:facial expression,leg movement,posture,crying,and consolability.If the FLACC score was ≥ 4,fentanyl 0.5 μg/kg was administered intravenously for rescue analgesia,with a repeat dose after 10 minutes if necessary (maximum cumulative dose not to exceeding 2 μg/kg).The number of patients requiring rescue analgesia and the number of times rescue analgesia was administered were recorded.Additionally,information such as age,gender,body mass index,and diagnosis were collected from the electronic medical records,and anesthesia duration and extubation time were recorded from the anesthesia records. Results The FLACC scores at T1 and T2 time points in the observation group were 2.0±2.4 and 0.6±1.0,respectively,compared to 3.5±2.8 and 1.4±1.4 in the control group,with significant differences between the two groups (P<0.05).No significant differences were found in FLACC scores at other time points between the two groups (P>0.05).In the observation group,there was no significant differences in FLACC scores from T2 to T8 (P>0.05).In the control group,there were no significant differences in FLACC scores between T2 and T3 (P>0.05);however,FLACC scores at T4 to T8 were significantly lower than at T2 and T3 (P<0.05),The number of patients requiring rescue analgesia with fentanyl was statistically lower in the observation group than in the control group9/52 (17.3%) vs.21/54(38.9%);P<0.05].Additionally,the number of patients requiring more than one rescue analgesia with fentanyl was also significantly lower in the observation group compared to the control group[4/52 (7.7%) vs.15/54 (27.8%);P<0.05]. Conclusions Prophylactic intravenous injection of ibuprofen during surgery can significantly alleviate postoperative awakening pain in children aged 3 to 9 years undergoing tonsillectomy (with or without adenoidectomy),while also reducing the need for rescue analgesic medications.
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Memo
收稿日期:2024-6-22。
通讯作者:张建敏,Email:zjm428@sina.com