门诊扁桃体切除术后泼尼松龙与布洛芬镇痛方案的管理调查。

A survey of the administration of prednisolone versus ibuprofen analgesic protocols after ambulatory tonsillectomy.

机构信息

Department of anaesthesiology and intensive care, centre hospitalier Privé-Sévigné, 3, rue du Chêne-Germain, 35510 Cesson-Sévigné, France.

出版信息

Anaesth Crit Care Pain Med. 2015 Oct;34(5):281-7. doi: 10.1016/j.accpm.2014.11.003. Epub 2015 May 23.

DOI:10.1016/j.accpm.2014.11.003

PMID:26004877

Abstract

INTRODUCTION

Postoperative pain, nausea and vomiting are frequent symptoms after tonsillectomy. There have been controversies concerning the advantages and drawbacks of different analgesics in this setting, especially non-steroidal anti-inflammatory drugs, because of potential side effects. We have evaluated the effectiveness and safety of a shift from prednisolone to ibuprofen for postoperative analgesia after tonsillectomy.

PATIENTS AND METHODS

Data from 1231 children scheduled for tonsillectomy over a period of 30 months were analysed. During the first period, children received a combination of paracetamol-prednisolone with codeine as a rescue therapy; in the second period, they received paracetamol and ibuprofen, with tramadol as a rescue therapy. All children received IV dexamethasone at 0.1mg/kg for antiemetic prophylaxis. The primary end-point was the incidence of severe pain defined as an Objective Pain Scale (OPS) score≥6 at the seventh postoperative day (POD7). Other end-points were postoperative nausea or emesis (PONV), sleep disturbance, oral intake and postoperative haemorrhage and reoperation.

RESULTS

Six hundred and seventy-two and 559 children were included in the prednisolone and ibuprofen groups respectively. OPS scores≥6 were observed in 3.1% of cases (95% confidence interval, 2.3-4.2%) on POD7 for the entire study population. Ibuprofen reduced the incidence of OPS scores≥6 on POD7 (relative risk 0.37, 95% CI: 0.18-0.78; P=0.009), OPS scores in the ambulatory unit (P<0.001) and POD1 (P<0.001), nalbuphine requirements (RR 0.42, 95% CI, 0.34-0.5, P<0.0001), and PONV (P=0.01) compared with prednisolone. Ibuprofen enhanced sleep quality on POD0 (P<0.0001) and POD7 (P=0.02), and oral intake on POD1 (P<0.0001). The incidence of bleeding requiring reoperation was comparable between the two groups (RR 0.8 [95% CI, 0.13-4.78], p=0.8). Predictive factors for an OPS score≥6 at POD7 were OPS score>4 on the morning and the evening of POD1 (OR 1.24, 95% CI 1.02-1.49, P=0.03 and OR 1.30, 95% CI 1.12-1.55, P=0.008, respectively) and prednisolone use (OR 2.37, 95% CI 1.06-5.31, P=0.04).

CONCLUSION

The administration of ibuprofen compared to prednisolone improves postoperative comfort in children undergoing ambulatory tonsillectomy without increasing the incidence of side effects.

摘要

简介

扁桃体切除术后常出现疼痛、恶心和呕吐等症状。由于潜在的副作用，在这种情况下，不同镇痛药物的优势和弊端一直存在争议，尤其是非甾体抗炎药。我们评估了将泼尼松龙转为布洛芬用于扁桃体切除术后镇痛的效果和安全性。

患者和方法

分析了在 30 个月期间计划行扁桃体切除术的 1231 例儿童的数据。在第一个时期，儿童接受对乙酰氨基酚-泼尼松龙联合可待因作为解救疗法；在第二个时期，他们接受对乙酰氨基酚和布洛芬，曲马多作为解救疗法。所有儿童均接受 IV 地塞米松 0.1mg/kg 预防止吐。主要终点是术后第 7 天（POD7）时 OPS 评分≥6 的严重疼痛发生率。其他终点包括术后恶心或呕吐（PONV）、睡眠障碍、口服摄入和术后出血以及再次手术。

结果

泼尼松龙组和布洛芬组分别有 672 例和 559 例儿童纳入研究。整个研究人群中，POD7 时 OPS 评分≥6 的病例发生率为 3.1%（95%置信区间，2.3-4.2%）。与泼尼松龙相比，布洛芬降低了 POD7 时 OPS 评分≥6 的发生率（相对风险 0.37，95%CI：0.18-0.78；P=0.009）、门诊单位（P<0.001）和 POD1（P<0.001）的 OPS 评分、纳布啡需求（RR 0.42，95%CI，0.34-0.5，P<0.0001）和 PONV（P=0.01）。与泼尼松龙相比，布洛芬还改善了 POD0（P<0.0001）和 POD7（P=0.02）的睡眠质量，以及 POD1 的口服摄入量（P<0.0001）。两组出血需要再次手术的发生率相当（RR 0.8 [95%CI，0.13-4.78]，p=0.8）。POD7 时 OPS 评分≥6 的预测因素是 POD1 早晚 OPS 评分>4（OR 1.24，95%CI 1.02-1.49，P=0.03 和 OR 1.30，95%CI 1.12-1.55，P=0.008）和使用泼尼松龙（OR 2.37，95%CI 1.06-5.31，P=0.04）。