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,2024,(09):866-871.[doi:10.3760/cma.j.cn101785-202406040-012]
布洛芬注射液预防性镇痛对于儿童扁桃体切除术后苏醒期疼痛的作用研究
- Title:
- 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
- 摘要:
- 目的 观察儿童扁桃体(伴或不伴腺样体)切除术中预防性应用布洛芬注射液对于缓解患儿手术后苏醒期疼痛的效果。方法 本研究为前瞻性、单中心、双盲、随机对照研究。纳入2021年4月至2021年9月于首都医科大学附属北京儿童医院行全身麻醉下扁桃体(伴或不伴腺样体)切除术的106例患儿作为研究对象,年龄3~9岁,男57例、女49例。采用随机数字表法分为观察组(使用布洛芬注射液)52例和对照组(不使用布洛芬注射液)54例。均采用统一的麻醉诱导和全凭静脉维持方案。观察组于手术开始时静脉输注布洛芬注射液,剂量为10 mg/kg(极量为400 mg),用0.9%氯化钠注射液稀释,最终使用浓度不超过4 mg/mL,输注时间15 min。记录两组患儿苏醒后2 h内、以15 min为间隔的8个时间点(分别记为T1、T2、T3、T4、T5、T6、T7、T8)疼痛评分。疼痛评分采用FLACC评分(Face,Legs,Activity,Cry,Consolability score,FLACC,分别代表面部表情、腿部活动、体位、哭闹、可安慰度五个方面)。当FLACC评分≥4分,则静脉单次给予芬太尼0.5 μg/kg进行补救镇痛,10 min后可根据需要重复使用(最大累积剂量不超过2 μg/kg),记录补救镇痛的人数及次数。同时从电子病例系统收集患儿年龄、性别、体重指数、诊断等信息,从麻醉记录中收集麻醉持续时间和拔管时间。结果 T1和T2时间点的FLACC评分在观察组分别为(2.0±2.4)分和(0.6±1.0)分,对照组分别为(3.5±2.8)分和(1.4±1.4)分,两组差异有统计学意义(P<0.05)。两组其他时间点的FLACC评分差异无统计学意义(P＞0.05)。观察组T2~T8时间点的FLACC评分差异无统计学意义(P＞0.05);对照组T2和T3时间点的FLACC评分差异无统计学意义(P＞0.05),T4~T8时间点的FLACC评分均低于T2和T3时间点的FLACC分数,差异有统计学意义(P<0.05)。观察组接受芬太尼补救镇痛的人数较对照组少[（9/52，17.3%）比（21/54，38.9%）],差异有统计学意义(P<0.05);接受1次以上芬太尼补救镇痛的人数亦较对照组少[（4/52，7.7%）比（15/54，27.8%）],差异有统计学意义(P<0.05)。结论 术中预防性静脉注射布洛芬注射液可明显缓解3~9岁儿童扁桃体(伴或不伴腺样体)切除术后苏醒期疼痛,同时减少补救性镇痛药物的用量。
- 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.
参考文献/References:
[1] Working Group of Chinese Guideline for the Diagnosis and Treatment of Childhood OSA,Subspecialty Group of Pediatrics,Society of Otorhinolaryngology Head and Neck Surgery,Chinese Medical Association,Subspecialty Group of Respiratory Diseases,Society of Pediatrics,Chinese Medical Association,et al.Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020)[J].Pediatr Investig,2021,5(3):167-187.DOI:10.1002/ped4.12284.
[2] Salonen A,Kokki H,Nuutinen J.The effect of ketoprofen on recovery after tonsillectomy in children:a 3-week follow-up study[J].Int J Pediatr Otorhinolaryngol,2002,62(2):143-150.DOI:10.1016/s0165-5876(01)00610-3.
[3] Baugh RF,Archer SM,Mitchell RB,et al.Clinical practice gui-deline:tonsillectomy in children[J].Otolaryngol Head Neck Surg,2011,144(1 Suppl):S1-S30.DOI:10.1177/0194599818801757.
[4] Kanaya A.Emergence agitation in children:risk factors,prevention,and treatment[J].J Anesth,2016,30(2):261-267.DOI:10.1007/s00540-015-2098-5.
[5] Jin ZS,Lee C,Zhang K,et al.Safety of treatment options available for postoperative pain[J].Expert Opin Drug Saf,2021,20(5):549-559.DOI:10.1080/14740338.2021.1898583.
[6] Jensen DR.Pharmacologic management of post-tonsillectomy pain in children[J].World J Otorhinolaryngol Head Neck Surg,2021,7(3):186-193.DOI:10.1016/j.wjorl.2021.03.004.
[7] Rudikoff AG,Tieu DD,Banzali FM,et al.Perioperative acetaminophen and dexmedetomidine eliminate post-operative opioid requirement following pediatric tonsillectomy[J].J Clin Med,2022,11(3):561.DOI:10.3390/jcm11030561.
[8] Faramarzi M,Roosta S,Eghbal MH,et al.Comparison of celecoxib and acetaminophen for pain relief in pediatric day case tonsillectomy:a randomized double-blind study[J].Laryngoscope Investig Otolaryngol,2021,6(6):1307-1315.DOI:10.1002/lio2.685.
[9] Lal A,Chohan K,Chohan A,et al.Role of honey after tonsillectomy:a systematic review and meta-analysis of randomised controlled trials[J].Clin Otolaryngol,2017,42(3):651-660.DOI:10.1111/coa.12792.
[10] Mitchell RB,Archer SM,Ishman SL,et al.Clinical practice guideline:tonsillectomy in children (update)-executive summary[J].Otolaryngol Head Neck Surg,2019,160(2):187-205.DOI:10.1177/0194599818807917.
[11] Barbagallo M,Sacerdote P.Ibuprofen in the treatment of chil-dren’s inflammatory pain:a clinical and pharmacological overview[J].Minerva Pediatr,2019,71(1):82-99.DOI:10.23736/S0026-4946.18.05453-1.
[12] Bruno A,Tacconelli S,Patrignani P.Variability in the response to non-steroidal anti-inflammatory drugs:mechanisms and perspectives[J].Basic Clin Pharmacol Toxicol,2014,114(1):56-63.DOI:10.1111/bcpt.12117.
[13] Moss JR,Watcha MF,Bendel LP,et al.A multicenter,randomized,double-blind placebo-controlled,single dose trial of the safety and efficacy of intravenous ibuprofen for treatment of pain in pediatric patients undergoing tonsillectomy[J].Paediatr Anaesth,2014,24(5):483-489.DOI:10.1111/pan.12381.
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备注/Memo
收稿日期:2024-6-22。
通讯作者:张建敏,Email:zjm428@sina.com