Viitanen H, Tuominen N, Vääräniemi H, Nikanne E, Annila P
Department of Anaesthesia, Central Hospital of Seinäjoki, Seinäjoki, Finland.
Br J Anaesth. 2003 Sep;91(3):363-7. doi: 10.1093/bja/aeg196.
Acetaminophen and non-steroidal anti-inflammatory drugs have different mechanisms of action. We investigated if combining rectal acetaminophen with ibuprofen would provide better postoperative analgesia compared with either drug alone after adenoidectomy in children.
160 children, aged 1-6 yr, undergoing day-case adenoidectomy, were randomized to receive either acetaminophen 40 mg kg(-1), ibuprofen 15 mg kg(-1), their combination, or placebo rectally immediately after anaesthetic induction. A standard anaesthetic method was used and all children received alfentanil 10 micro g kg(-1) i.v. during induction. Meperidine 5-10 mg i.v. was used for rescue analgesia for a pain score (Objective Pain Scale) over 3. Recovery times, sedation scores and the need for rescue analgesia and adverse events during the first 24 h after anaesthesia were recorded. Rescue analgesic at home was ibuprofen 10 mg kg(-1).
Total meperidine requirements were significantly less in the groups receiving acetaminophen, ibuprofen, or their combination compared with the group receiving placebo indicating an opioid-sparing effect of 19-28% (P<0.05). Children given acetaminophen were more sedated than those given ibuprofen (P<0.05). Discharge criteria were fulfilled earlier in the ibuprofen group than in all the other groups (P<0.05). At home, less children (49%) needed rescue analgesia in the combination group compared with the other groups (74-77%) (P<0.02).
We conclude that prophylactically administered rectal acetaminophen combined with ibuprofen does not improve analgesia after adenoidectomy in the immediate postoperative period compared with either drug alone but does decrease the need for analgesia at home. Ibuprofen results in lesser sedation and faster discharge than when acetaminophen is used.
对乙酰氨基酚和非甾体抗炎药有不同的作用机制。我们研究了在儿童腺样体切除术后，直肠给予对乙酰氨基酚与布洛芬联合用药是否比单独使用任一药物能提供更好的术后镇痛效果。
160名年龄在1至6岁行日间腺样体切除术的儿童，在麻醉诱导后立即随机分为直肠给予对乙酰氨基酚40mg/kg、布洛芬15mg/kg、二者联合用药或安慰剂组。采用标准麻醉方法，所有儿童在诱导期间静脉注射阿芬太尼10μg/kg。静脉注射哌替啶5 - 10mg用于疼痛评分（客观疼痛量表）超过3分时的解救镇痛。记录麻醉后前24小时的恢复时间、镇静评分、解救镇痛需求及不良事件。在家中使用的解救镇痛药为布洛芬10mg/kg。
与接受安慰剂组相比，接受对乙酰氨基酚、布洛芬或二者联合用药组的哌替啶总需求量显著减少，表明阿片类药物节省效应为19% - 28%（P<0.05）。给予对乙酰氨基酚的儿童比给予布洛芬的儿童镇静作用更强（P<0.05）。布洛芬组比其他所有组更早达到出院标准（P<0.05）。在家中，联合用药组需要解救镇痛的儿童（49%）比其他组（74% - 77%）少（P<0.02）。
我们得出结论，与单独使用任一药物相比，预防性直肠给予对乙酰氨基酚联合布洛芬在腺样体切除术后即刻并未改善镇痛效果，但确实减少了在家中对镇痛的需求。与使用对乙酰氨基酚相比，布洛芬导致的镇静作用较轻且出院更快。
