Children's Hospital Central California, Madera, CA 93636-8761, USA.
Clin J Pain. 2010 Feb;26(2):95-103. doi: 10.1097/AJP.0b013e3181b85f98.
To determine the effectiveness of around-the-clock (ATC) analgesic administration, with or without nurse coaching, compared with standard care with as needed (PRN) dosing in children undergoing outpatient tonsillectomy.
Children 6 to 15 years of age were randomized to receive acetaminophen and hydrocodone (167 mg/2.5 mg/5 mL) for 3 days after surgery: Group A (N=39)-every 4 hours PRN, with standard postoperative instructions; Group B (N=34)-every 4 hours ATC, with standard postoperative instructions, without nurse coaching; and Group C (N=40)-every 4 hours ATC, with standard postoperative instructions, with coaching. Parents completed a medication log, and recorded the presence and severity of opioid-related adverse effects and children's reports of pain intensity using a 0 to 10 numeric rating scale.
No differences were found in analgesic administration or pain intensity scores between the 2 ATC groups. Therefore, they were combined for comparison with the PRN group. Children in the ATC group received more analgesic than those in the PRN group (P<0.0001). Children in the PRN group had higher pain intensity scores compared to children in the ATC group, both at rest (P=0.017) and with swallowing (P=0.017). Pain intensity scores for both groups were higher in the morning compared with the evening (P<0.0001). With the exception of constipation, scheduled analgesic dosing did not increase the frequency or severity of opioid-related adverse effects.
Scheduled dosing of acetaminophen and hydrocodone is more effective than PRN dosing in reducing pain intensity in children after tonsillectomy. Nurse coaching does not impact parent's adherence to ATC dosing.
确定 24 小时镇痛给药（ATC），联合或不联合护士指导，与门诊扁桃体切除术患儿的按需（PRN）给药标准护理相比的效果。
6 至 15 岁的儿童随机分为术后 3 天接受对乙酰氨基酚和氢可酮（167mg/2.5mg/5mL）：A 组（N=39）-PRN 每 4 小时给药，给予标准术后指导；B 组（N=34）-ATC 每 4 小时给药，给予标准术后指导，不进行护士指导；C 组（N=40）-ATC 每 4 小时给药，给予标准术后指导，同时进行指导。父母完成用药记录，并使用 0 到 10 的数字评分量表记录阿片类药物相关不良反应的发生和严重程度以及儿童疼痛强度报告。
在 ATC 组之间，镇痛给药或疼痛强度评分没有差异。因此，将它们合并与 PRN 组进行比较。与 PRN 组相比，ATC 组的儿童接受了更多的镇痛药物（P<0.0001）。PRN 组的儿童在休息时（P=0.017）和吞咽时（P=0.017）的疼痛强度评分均高于 ATC 组的儿童。两组的疼痛强度评分在早上均高于晚上（P<0.0001）。除便秘外，计划镇痛给药不会增加阿片类药物相关不良反应的频率或严重程度。
与 PRN 给药相比，对乙酰氨基酚和氢可酮的定时给药可更有效地减轻扁桃体切除术后儿童的疼痛强度。护士指导不影响父母对 ATC 给药的依从性。
