Hayes J A, Forrest C R, Walsh W, Pétroz G C, Adeli K, Bissonnette B
Cleft Palate Craniofac J. 2011 Sep;48(5):532-7. doi: 10.1597/10-148. Epub 2010 Nov 23.
To investigate the use of intravenous ketorolac and iliac crest bupivacaine infusion in the management of iliac crest donor-site pain in the pediatric cleft population. The null hypothesis was there is no difference with respect to pain scores between ketorolac and iliac crest bupivacaine infusion as analgesic adjuncts to intravenous opioids.
A total of 54 children and adolescents (27 boys, 27 girls) undergoing alveolar cleft repair or Le Fort I osteotomy were assigned randomly in a prospective, single-blinded fashion to one of three groups: intravenous ketorolac plus iliac crest normal saline infusion, intravenous ketorolac plus iliac crest bupivacaine infusion, or iliac crest bupivacaine infusion alone. Iliac crest infusions and ketorolac were administered for 48 hours or until discharge, whichever occurred first. All patients received morphine via a patient-controlled analgesia device.
MAIN OUTCOME MEASURE(S): Primary outcome was pain score, and secondary outcomes were morphine consumption and satisfaction scores.
Pain scores, morphine consumption, and satisfaction scores were not significantly different among groups. Estimated costs were significantly higher for bupivacaine infusion than intravenous ketorolac.
Iliac crest donor-site pain is well managed in this patient population. Intravenous ketorolac and iliac crest bupivacaine infusion provide comparable analgesia for iliac crest bone graft donor-site pain in children and adolescents.
探讨静脉注射酮咯酸和髂嵴布比卡因输注在小儿腭裂患者髂嵴供区疼痛管理中的应用。无效假设是，作为静脉注射阿片类药物的镇痛辅助剂，酮咯酸和髂嵴布比卡因输注在疼痛评分方面没有差异。
共有54名接受牙槽嵴裂修复或勒福Ⅰ型截骨术的儿童和青少年（27名男孩，27名女孩），以前瞻性、单盲方式随机分配到三组中的一组：静脉注射酮咯酸加髂嵴生理盐水输注、静脉注射酮咯酸加髂嵴布比卡因输注或单纯髂嵴布比卡因输注。髂嵴输注和酮咯酸给药48小时或直至出院，以先发生者为准。所有患者均通过患者自控镇痛装置接受吗啡治疗。
主要结局是疼痛评分，次要结局是吗啡消耗量和满意度评分。
各组之间的疼痛评分、吗啡消耗量和满意度评分无显著差异。布比卡因输注的估计成本显著高于静脉注射酮咯酸。
该患者群体的髂嵴供区疼痛得到了良好管理。静脉注射酮咯酸和髂嵴布比卡因输注为儿童和青少年髂嵴骨移植供区疼痛提供了相当的镇痛效果。
