Hayes Jason, Pehora Carolyne, Bissonnette Bruno
Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
Paediatr Anaesth. 2009 Aug;19(8):756-63. doi: 10.1111/j.1460-9592.2009.03060.x.
Pediatric scoliosis surgery is associated with considerable postoperative pain requiring opioids for analgesia. Nonsteroidal antiinflammatory drugs (NSAIDs) can be used as adjuvants for analgesia; however, the potential of these agents to affect bone healing raises concerns. No large-scale prospective studies have been performed to evaluate the benefit-to-risk ratio of NSAID use after pediatric scoliosis surgery. Given the lack of evidence in the literature, a survey of practice patterns of anesthesiologists from around the world was conducted with respect to the use of NSAIDs after pediatric spinal fusion surgery for scoliosis.
One hundred and fourteen anesthesiologists from international academic pediatric hospitals were asked to complete an online survey. After 1 month, nonresponders were sent a second e-mail asking for their participation. All questions were developed specifically for this study.
Out of 80 anesthesiologists who responded 61 were included in the final analysis. Fifty-nine percent routinely use NSAIDs, the most common agents being intravenous ketorolac and oral ibuprofen. The majority of respondents begin to administer NSAIDs within the first three postoperative days for a duration of four or more days. The primary reason for not routinely prescribing NSAIDs was the risk of bone nonunion.
This survey demonstrates that the practice patterns of pediatric anesthesiologists from around the world with respect to the administration of NSAIDs for the management of postoperative pain after pediatric spinal fusion reflects the conflicting evidence in the literature and the lack of high-quality studies in humans.
小儿脊柱侧弯手术术后疼痛剧烈，需要使用阿片类药物镇痛。非甾体类抗炎药（NSAIDs）可作为镇痛辅助药物；然而，这些药物影响骨愈合的可能性引发了担忧。尚未进行大规模前瞻性研究来评估小儿脊柱侧弯手术后使用NSAIDs的利弊比。鉴于文献中缺乏证据，针对小儿脊柱侧弯后路融合术后NSAIDs的使用情况，对来自世界各地的麻醉医生的实践模式进行了一项调查。
邀请来自国际学术性儿科医院的114名麻醉医生完成一项在线调查。1个月后，向未回复者发送第二封电子邮件，请求他们参与。所有问题均为此项研究专门设计。
在回复的80名麻醉医生中，61名被纳入最终分析。59%的医生常规使用NSAIDs，最常用的药物是静脉注射酮咯酸和口服布洛芬。大多数受访者在术后头三天内开始使用NSAIDs，持续时间为四天或更长时间。不常规开具NSAIDs的主要原因是骨不连的风险。
这项调查表明，世界各地小儿麻醉医生在小儿脊柱融合术后使用NSAIDs管理术后疼痛的实践模式，反映了文献中相互矛盾的证据以及缺乏高质量的人体研究。
