Pierson Brandon W, Cardon Brandon S, Anderson Michael P, Glade Robert S
Cleft Palate Craniofac J. 2017 Mar;54(2):170-174. doi: 10.1597/15-135. Epub 2016 Feb 16.
This article evaluates postoperative analgesia in pediatric palatoplasty patients using nonopioid oral medications.
This study was a retrospective chart review.
The setting for this study was a tertiary-care children's hospital.
Study participants were pediatric patients who underwent palatoplasty procedures performed by a single surgeon.
Interventions included nonopioid and opioid oral medications for postoperative analgesia.
The adequacy of nonopioid versus opioid oral analgesia was assessed by (1) time to discontinue IV fluid, (2) total IV morphine doses for breakthrough pain, (3) daily IV morphine doses for breakthrough pain, (4) time to discharge from the hospital, and (5) perioperative weight change. Group comparisons of outcome measures were performed using a two one-sided test.
A total of 61 patients were identified who received three standard pain regimens: acetaminophen + ibuprofen (12), hydrocodone/acetaminophen (23), and hydrocodone/acetaminophen + ibuprofen (26). There was sufficient evidence to suggest equivalence in outcome measures for acetaminophen + ibuprofen versus hydrocodone/acetaminophen and hydrocodone/acetaminophen + ibuprofen for the following: time to discontinue IV fluid (P = .02, 90% confidence interval [CI] = -0.42 to 0.17; P = .007, 90% CI = -0.28 to 0.34), daily IV morphine doses (P = .023, 90% CI = -0.83 to 0.65; P = .032, 90% CI = -0.92 to 0.28), time to discharge from the hospital (P = .017, 90% CI = -0.40 to 0.27; P = .015, 90% CI = -0.24 to 0.39), and perioperative weight change (P = .002; 90% CI = -0.25 to 0.46; P < .0001; 90% CI = -0.34 to 0.18). There was no sufficient evidence to suggest equivalence for total IV morphine doses (P = .189, 90% CI = -1.51 to 1.78; P = .169, 90% CI = -1.51 to 0.88).
Oral acetaminophen and ibuprofen alone may provide similar analgesia to traditional regimens with reduced risks following pediatric palatoplasty.
本文评估使用非阿片类口服药物对小儿腭裂修复术患者进行术后镇痛的效果。
本研究为回顾性病历审查。
本研究的地点是一家三级护理儿童医院。
研究参与者为接受由单一外科医生实施腭裂修复手术的儿科患者。
干预措施包括用于术后镇痛的非阿片类和阿片类口服药物。
通过以下方面评估非阿片类与阿片类口服镇痛的充分性：(1)停止静脉输液的时间；(2)用于突破性疼痛的静脉注射吗啡总剂量；(3)用于突破性疼痛的每日静脉注射吗啡剂量；(4)出院时间；(5)围手术期体重变化。使用双侧单侧检验对观察指标进行组间比较。
共确定61例患者接受了三种标准疼痛治疗方案：对乙酰氨基酚+布洛芬(12例)、氢可酮/对乙酰氨基酚(23例)以及氢可酮/对乙酰氨基酚+布洛芬(26例)。有充分证据表明，在以下方面，对乙酰氨基酚+布洛芬与氢可酮/对乙酰氨基酚及氢可酮/对乙酰氨基酚+布洛芬的观察指标相当：停止静脉输液的时间(P = 0.02，90%置信区间[CI]= -0.42至0.17；P = 0.007，90%CI = -0.28至0.34)、每日静脉注射吗啡剂量(P = 0.023，90%CI = -0.83至0.65；P = 0.032，90%CI = -0.92至0.28)、出院时间(P = 0.017，90%CI = -0.40至0.27；P = 0.015，90%CI = -0.24至0.39)以及围手术期体重变化(P = 0.002；90%CI = -0.25至0.46；P < 0.0001；90%CI = -0.34至0.18)。没有充分证据表明静脉注射吗啡总剂量相当(P = 0.189，90%CI = -1.51至1.78；P = 0.169，90%CI = -1.51至0.88)。
小儿腭裂修复术后，单独使用口服对乙酰氨基酚和布洛芬可能提供与传统方案相似的镇痛效果，且风险降低。
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