儿童腺样体切除术和扁桃体切除术（扁桃体切除铡除术）术后第一周的疼痛情况。

Postoperative pain during the first week after adenoidectomy and guillotine adenotonsillectomy in children.

作者信息

Vons Kristy M J, Bijker Jilles B, Verwijs Edwin W, Majoor Maarten H J M, de Graaff Jurgen C

机构信息

Department of Anesthesia, Gelderse Vallei Hospital, Ede, The Netherlands.

出版信息

Paediatr Anaesth. 2014 May;24(5):476-82. doi: 10.1111/pan.12383. Epub 2014 Mar 20.

DOI:10.1111/pan.12383

PMID:24646093

Abstract

BACKGROUND

Adenoidectomy (AD) and adenotonsillectomy (ATE) are frequently occurring and often painful interventions in children. In literature, it is very prevalent that postoperative pain in children following ATE is hard to control. The purpose of this study was to evaluate the prevalence and severity of postoperative pain in children undergoing AD and ATE in the ambulatory setting.

METHODS

A prospective cohort study was performed including 167 children aged 0-12 years, undergoing AD using an adenotome and ATE using the guillotine technique in day care. Children undergoing AD received acetaminophen pre- and postoperatively. Children undergoing ATE received acetaminophen and diclofenac preoperatively, sufentanyl postoperative and a prescription of around-the-clock treatment with acetaminophen and diclofenac at home. Pain intensity and analgesic consumption were recorded in hospital using the Faces, Legs, Activity, Cry and Consolability-scale (FLACC), as well as during a 1-week follow-up period at home using the Parents' Postoperative Pain Measure (PPPM) and Visual Analogue Scale (VAS) scores.

RESULTS

All children left the recovery room with adequate pain scores and were discharged with a median VAS of two after ATE and one after AD. The PPPM and VAS scores were highest at the first measurement at home for AD patients (VAS = 2.0 and PPPM = 1.5) and ATE patients (VAS = 4.5 and PPPM = 9). On the second postoperative day, AD patients scored 0.0 points on both VAS and PPPM. ATE patients scored at that time 3.0 point on the VAS and 6.0 points using the PPPM. Despite high adherence to pain treatment, daytime activities normalized after an average of 2 and 7 days after AD and ATE, respectively.

CONCLUSION

Examination of the PPPM and VAS scores illustrated that children undergoing AD were comfortable with acetaminophen as a single analgesic, whereas children undergoing ATE experience significant pain for up to two postoperative days when treated with acetaminophen and diclofenac.

摘要

背景

腺样体切除术（AD）和腺样体扁桃体切除术（ATE）在儿童中是常见且常伴有疼痛的手术。在文献中，ATE术后儿童的疼痛难以控制的情况非常普遍。本研究的目的是评估在门诊环境中接受AD和ATE的儿童术后疼痛的发生率和严重程度。

方法

进行了一项前瞻性队列研究，纳入了167名0至12岁的儿童，他们在日间护理中心接受使用腺样体刀的AD手术和使用断头台技术的ATE手术。接受AD手术的儿童在术前和术后服用对乙酰氨基酚。接受ATE手术的儿童在术前服用对乙酰氨基酚和双氯芬酸，术后服用舒芬太尼，并在家中接受对乙酰氨基酚和双氯芬酸的全天候治疗处方。在医院使用面部、腿部、活动、哭闹和安慰量表（FLACC）记录疼痛强度和镇痛药消耗量，并在术后1周的家庭随访期间使用家长术后疼痛量表（PPPM）和视觉模拟量表（VAS）评分。

结果

所有儿童离开恢复室时疼痛评分均适宜，ATE术后出院时VAS中位数为2，AD术后为1。AD患者在家中首次测量时PPPM和VAS评分最高（VAS = 2.0，PPPM = 1.5），ATE患者（VAS = 4.5，PPPM = 9）。术后第二天，AD患者VAS和PPPM均得0.0分。此时ATE患者VAS得3.0分，PPPM得6.0分。尽管对疼痛治疗的依从性很高，但AD和ATE术后白天活动分别平均在2天和7天后恢复正常。