Miura Mauricio Schreiner, Saleh Catia, de Andrade Marina, Assmann Melina, Lima Lucélia Hernandes, Lubianca Neto José Faibes
Department of Medical Surgery of Universidade Federal de Ciências da Saúde de Porto Alegre and Division of Pediatric Otorhinolaryngology at Hospital da Criança Santo Antônio, Programa de Pós-Graduação em Ciências Médicas-Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Otolaryngol Head Neck Surg. 2009 Oct;141(4):509-15. doi: 10.1016/j.otohns.2009.06.082.
Tonsillectomy, with or without adenoidectomy, is one of the most common surgical procedures in pediatric otolaryngology. Pain is the main cause of morbidity in the postoperative period, where it is serious in some cases, leading to odynophagia and resultant complications such as dehydration. We evaluated the effect of topical clindamycin in the reduction of oropharyngeal pain in children who underwent adenotonsillectomy. Secondary outcomes were otalgia, analgesic use, oral bacterial count, type of diet, secondary bleeding, vomiting, fever, and weight loss.
Double-blind, randomized clinical trial.
Tertiary hospital.
Eighty-two children of both sexes between four and 12 years of age who underwent adenotonsillectomy were allocated to receive topical clindamycin or placebo in the immediate preoperative, intraoperative, and eight-to-12-hours postoperative periods. Pain was measured using a faces pain scale for five days.
Reduction of oropharyngeal pain was significant with the use of clindamycin only on the first postoperative day (95% confidence interval, 2.22 to 4.41 [clindamycin] vs 4.53 to 6.3 [placebo]; P = .002). No difference was observed in the aerobic and anaerobic counts by tongue swab between premedication and third-postoperative-day samplings. There were no differences with respect to reduction in otalgia, paracetamol use, return to normal diet, variation in weight, secondary hemorrhage, vomiting, and fever.
The use of topical clindamycin was beneficial in reducing pain on the first postoperative day, without effect on subsequent days. Future investigations could examine the use of topical clindamycin not only in the first 12 hours but also during five days of follow-up.
扁桃体切除术，无论是否同时行腺样体切除术，都是小儿耳鼻咽喉科最常见的外科手术之一。疼痛是术后发病的主要原因，在某些情况下疼痛严重，导致吞咽痛及诸如脱水等并发症。我们评估了局部应用克林霉素对接受腺样体扁桃体切除术儿童口咽疼痛减轻的效果。次要观察指标为耳痛、镇痛药使用情况、口腔细菌计数、饮食类型、继发性出血、呕吐、发热及体重减轻。
双盲随机临床试验。
三级医院。
82例4至12岁接受腺样体扁桃体切除术的儿童被分配在术前即刻、术中及术后8至12小时接受局部应用克林霉素或安慰剂。使用面部疼痛量表测量疼痛，持续5天。
仅在术后第1天使用克林霉素时口咽疼痛减轻显著（95%置信区间，2.22至4.41[克林霉素组]对比4.53至6.3[安慰剂组]；P = 0.002）。术前用药与术后第3天取样时，通过舌拭子进行的需氧菌和厌氧菌计数无差异。在耳痛减轻、对乙酰氨基酚使用、恢复正常饮食、体重变化、继发性出血、呕吐及发热方面无差异。
局部应用克林霉素有助于减轻术后第1天的疼痛，但对后续天数无影响。未来研究可探讨局部应用克林霉素不仅在最初12小时，而且在随访5天期间的使用情况。
