Antila Heikki, Manner Tuula, Kuurila Kaija, Salanterä Sanna, Kujala Risto, Aantaa Riku
Department of Anesthesiology and Intensive Care, University of Turku, Turku, Finland.
Paediatr Anaesth. 2006 May;16(5):548-53. doi: 10.1111/j.1460-9592.2005.01819.x.
Pain following tonsillectomy is often intense. Nonsteroidal anti-inflammatory drugs and opioids are effective, but both can cause adverse effects. Tramadol may be a viable alternative for post-tonsillectomy pain. This study was designed to compare the analgesic effects of ketoprofen and tramadol during the early recovery period after tonsillectomy.
Forty-five ASA class I children (9-15 years) were randomized to receive either saline, ketoprofen (2 mg.kg(-1)) or tramadol (1 mg.kg(-1)) after induction of anesthesia. Upon completion of surgery, the study treatment was continued as a 6 h intravenous (i.v.) infusion of another dose of saline, ketoprofen (2 mg.kg(-1)) or tramadol (1 mg.kg(-1)). Postoperatively, each patient received rescue analgesia with patient-controlled analgesia (PCA) device programmed to deliver 0.5 microg.kg(-1) bolus doses of fentanyl. Postoperative pain was assessed using Visual Analog Scale (VAS) during swallowing. Intraoperative blood loss was measured.
The total number of requests of PCA-fentanyl was significantly less in ketoprofen group compared with tramadol and placebo groups (P = 0.035 and P = 0.049, respectively, in pairwise comparisons) and the VAS scores for pain were significantly lower in ketoprofen group compared with tramadol (P = 0.044) or placebo groups (P = 0.018) during the first six postoperative hours. Measured intraoperative blood loss was greater in ketoprofen-treated patients than in those receiving placebo (P = 0.029).
A dose of 4 mg.kg(-1) of i.v. ketoprofen provided good pain relief with moderate supplemental PCA-fentanyl requirements during the first six postoperative hours after tonsillectomy in children whereas the effects of 2 mg.kg(-1) of i.v. tramadol did not differ from those of placebo.
扁桃体切除术后疼痛通常较为剧烈。非甾体类抗炎药和阿片类药物有效，但两者均可引起不良反应。曲马多可能是扁桃体切除术后疼痛的一种可行替代药物。本研究旨在比较酮洛芬和曲马多在扁桃体切除术后早期恢复阶段的镇痛效果。
45名美国麻醉医师协会（ASA）I级儿童（9至15岁）在麻醉诱导后随机接受生理盐水、酮洛芬（2mg·kg⁻¹）或曲马多（1mg·kg⁻¹）治疗。手术结束后，研究治疗继续进行，以6小时静脉输注另一剂量的生理盐水、酮洛芬（2mg·kg⁻¹）或曲马多（1mg·kg⁻¹）。术后，每位患者使用患者自控镇痛（PCA）装置接受解救镇痛，该装置设定为给予0.5μg·kg⁻¹的芬太尼推注剂量。术后吞咽时使用视觉模拟评分法（VAS）评估疼痛。测量术中失血量。
与曲马多组和安慰剂组相比，酮洛芬组PCA-芬太尼的总需求次数显著减少（两两比较时，P分别为0.035和0.049），且术后前6小时酮洛芬组的疼痛VAS评分显著低于曲马多组（P = 0.044）或安慰剂组（P = 0.018）。酮洛芬治疗的患者术中测量的失血量大于接受安慰剂治疗的患者（P = 0.029）。
静脉注射4mg·kg⁻¹的酮洛芬在儿童扁桃体切除术后的前6小时提供了良好的疼痛缓解，同时对PCA-芬太尼的补充需求适中，而静脉注射2mg·kg⁻¹的曲马多的效果与安慰剂无异。
