Oremule B, Johnson M, Sanderson L, Lutz J, Dodd J, Hans P
Blackpool Teaching Hospitals NHS Trust, Blackpool, UK.
Blackpool Teaching Hospitals NHS Trust, Blackpool, UK.
Int J Pediatr Otorhinolaryngol. 2015 Dec;79(12):2166-9. doi: 10.1016/j.ijporl.2015.09.040. Epub 2015 Oct 24.
The withdrawal of codeine for use in children following tonsillectomy enforced a change in our practice of providing regular paracetamol and ibuprofen, with codeine for breakthrough pain relief. Our objectives were to; examine the effectiveness of paracetamol and ibuprofen; examine the effectiveness of the addition of rescue (PRN) morphine to regular paracetamol and ibuprofen.
A 2 cycle prospective audit was conducted on our unit. Telephone consultations were conducted with parents of 74 children undergoing tonsillectomy and adenotonsillectomy. Cycle 1 (C1, without morphine) contained 24 consecutive patients and cycle 2 (C2, with morphine) contained 50 consecutive patients. Postoperative health service contact and outcome was recorded: worst pain scores on days 4 and 7 were obtained using validated pain assessment tools scoring 0-10. Cycle 2 results underwent subgroup analysis by method of surgery i.e. coblation (C2C) and cold steel dissection (C2D) groups.
More than half of parents felt simple analgesia was not effective enough in both cycles, this number was significantly higher in both 2nd cycle groups (C1=54%, C2C=74%, p=0.003, C2D=84%, p=0.0001). Mean worst pain reported at day 4 was similar for all groups, but the morphine groups reported higher pain at day 7 (C1 1.6, C2C 3.59, p=0.017, C2D 3.90, p=0.002). Antibiotic prescribing for children contacting a GP after surgery was significantly lower in the morphine groups (C1 24%, C2C 7%, p=0.0014, C2D 5%, p=0.0002). There was no difference in measured outcomes between the 2nd cycle groups.
This service evaluation found that postoperative morphine on an as-required basis, in addition to regular paracetamol and ibuprofen, did not significantly alter initial pain profile, worst pain scores or rate of health service contact when compared to regular paracetamol and ibuprofen alone. The majority of children in this study felt additional analgesia required. Children in the morphine groups experienced significantly less pharmacological intervention when contacting the GP after surgery.
在扁桃体切除术后儿童中停用可待因促使我们改变了常规提供对乙酰氨基酚和布洛芬，并使用可待因缓解突破性疼痛的做法。我们的目标是：研究对乙酰氨基酚和布洛芬的有效性；研究在常规对乙酰氨基酚和布洛芬基础上加用急救（必要时使用）吗啡的有效性。
在我们科室进行了一个两周期的前瞻性审计。对74例接受扁桃体切除术和腺样体扁桃体切除术的儿童的家长进行了电话咨询。第1周期（C1，不使用吗啡）包含24例连续患者，第2周期（C2，使用吗啡）包含50例连续患者。记录术后医疗服务接触情况和结果：使用0至10分的有效疼痛评估工具得出第4天和第7天的最严重疼痛评分。第2周期结果按手术方法进行亚组分析，即等离子消融术（C2C）组和冷钢剥离术（C2D）组。
超过一半的家长认为在两个周期中单纯镇痛效果都不够好，在第2周期的两个组中这一比例显著更高（C1 = 54%，C2C = 74%，p = 0.003，C2D = 84%，p = 0.0001）。所有组在第4天报告的平均最严重疼痛相似，但吗啡组在第7天报告的疼痛更高（C1为 \ 1.6，C2C为3.59，p = 0.017，C2D为3.90，p = 0.002）。在术后联系全科医生的儿童中，吗啡组的抗生素处方率显著更低（C1为24%，C2C为7%，p = 0.0014，C2D为5%，p = 0.0002）。第2周期的两组之间在测量结果上没有差异。
这项服务评估发现，与单独使用常规对乙酰氨基酚和布洛芬相比，在常规对乙酰氨基酚和布洛芬基础上按需使用术后吗啡并没有显著改变初始疼痛情况、最严重疼痛评分或医疗服务接触率。本研究中的大多数儿童认为需要额外的镇痛。吗啡组的儿童在术后联系全科医生时接受的药物干预显著更少。
