Korpela R, Korvenoja P, Meretoja O A
Department of Anesthesia, Hospital for Children and Adolescents, University of Helsinki, Finland.
Anesthesiology. 1999 Aug;91(2):442-7. doi: 10.1097/00000542-199908000-00019.
Postoperative pain is a major problem in day-case surgery in children. Nonsteroidal antiinflammatory drugs have gained popularity in management of pediatric surgical patients to reduce the need for opioids. The aim of this study was to evaluate the efficacy of different doses of rectal acetaminophen in day-case surgery in children.
A randomized, double-blinded, placebo-controlled study design was used. Patients (n = 120) were randomized to receive a single dose of 0, 20, 40, or 60 mg/kg of rectal acetaminophen after induction of anesthesia. General anesthesia was induced by mask ventilation with sevoflurane (7%) in nitrous oxide and oxygen and maintained with 2.5-4.0% end-tidal sevoflurane. Opioids or local anesthetics were not used. Postoperative pain was evaluated by behavioral assessment and physiologic measurements every 10 min after arrival at the postanesthesia care unit. The pain intensity was scored using a 0-100 visual analog scale used in the authors' clinic. The need for rescue medication, intravenous morphine 0.1 mg/kg, was decided by the nurse, who was unaware of the rectal acetaminophen dose. The parents were interviewed by phone after 24 h regarding pain and its treatment, nausea, and vomiting. Rescue analgesia at home was rectal ibuprofen, 10 mg/kg.
In the postanesthesia care unit pain scores were significantly lower in the 40- and 60-mg/kg groups compared with placebo and 20-mg/kg groups. Acetaminophen resulted in a dose-related reduction in the number of children who required postoperative rescue opioid, with significance reached with 40 or 60 mg/kg doses. Calculated dose of acetaminophen at which 50% of the children not requiring a rescue opioid was 35 mg/kg. The need for rescue analgesia at home during the first 24 h after surgery was also significantly less in patients in the 40- or 60-mg/kg groups than in the 0- or 20-mg/kg groups (20-17 vs. 80-63%). Thirty-three percent of patients receiving placebo had postoperative nausea and vomiting, compared with 0-3% in groups receiving 40 or 60 mg/kg acetaminophen.
A single dose of 40 or 60 mg/kg of rectal acetaminophen has a clear morphine-sparing effect in day-case surgery in children if administered at the induction of anesthesia. Moreover, children with adequate analgesia with acetaminophen have less postoperative nausea and vomiting.
术后疼痛是儿童日间手术中的一个主要问题。非甾体类抗炎药在小儿外科患者的管理中越来越受欢迎，以减少对阿片类药物的需求。本研究的目的是评估不同剂量直肠用对乙酰氨基酚在儿童日间手术中的疗效。
采用随机、双盲、安慰剂对照研究设计。患者（n = 120）在麻醉诱导后随机接受0、20、40或60 mg/kg的单次直肠用对乙酰氨基酚剂量。通过面罩通气用七氟醚（7%）在氧化亚氮和氧气中诱导全身麻醉，并用2.5 - 4.0%的呼气末七氟醚维持。未使用阿片类药物或局部麻醉剂。到达麻醉后护理单元后，每10分钟通过行为评估和生理测量评估术后疼痛。疼痛强度使用作者诊所使用的0 - 100视觉模拟量表进行评分。由不知道直肠用对乙酰氨基酚剂量的护士决定是否需要急救药物静脉注射吗啡0.1 mg/kg。24小时后通过电话采访父母关于疼痛及其治疗、恶心和呕吐情况。在家中的急救镇痛药物是直肠用布洛芬，10 mg/kg。
在麻醉后护理单元，40和60 mg/kg组的疼痛评分显著低于安慰剂组和20 mg/kg组。对乙酰氨基酚导致需要术后急救阿片类药物的儿童数量呈剂量相关减少，40或60 mg/kg剂量时达到显著差异。计算得出50%的儿童不需要急救阿片类药物时对乙酰氨基酚的剂量为35 mg/kg。术后24小时内，40或60 mg/kg组患者在家中需要急救镇痛的情况也显著少于0或20 mg/kg组（20 - 17%对80 - 63%）。接受安慰剂的患者中有33%出现术后恶心和呕吐，而接受40或60 mg/kg对乙酰氨基酚的组中为0 - 3%。
如果在麻醉诱导时给予，单次剂量40或60 mg/kg的直肠用对乙酰氨基酚在儿童日间手术中有明显的节省吗啡作用。此外，对乙酰氨基酚镇痛充分的儿童术后恶心和呕吐较少。
