Wilson Caroline A, Sommerfield David, Drake-Brockman Thomas F E, von Bieberstein Lita, Ramgolam Anoop, von Ungern-Sternberg Britta S
Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia.
School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia.
Paediatr Anaesth. 2016 Oct;26(10):992-1001. doi: 10.1111/pan.12974. Epub 2016 Jul 11.
It is well established that children experience significant pain for a considerable period following adenotonsillectomy. Less is known, however, about pain following other common head and neck operations.
The aim of this study was to describe the severity and duration of postoperative pain experienced by children undergoing elective head and neck procedures (primary outcomes). Behavioral disturbance, nausea and vomiting, parental satisfaction, and medical reattendance rates were also measured (secondary outcomes).
Parents of children (0-18 years) undergoing common head and neck operations were invited to participate. Pain scores on the day of surgery and each day post discharge were collected via multiple telephone interviews. Data collected included pain levels, analgesia prescribed and given, behavioral disturbance rates, and nausea and vomiting scores. Follow-up was continued until pain resolved.
Two hundred and fifty-one patients were analyzed (50 adenoidectomy, 51 adenotonsillectomy, 19 myringoplasty, 52 myringotomy, 43 strabismus, and 36 tongue tie divisions). On the day of surgery myringoplasty, strabismus surgery, and adenotonsillectomy patients on average had moderate pain, whereas adenoidectomy, tongue tie, and myringotomy patients had mild pain. Adenotonsillectomy patients continued to have moderate pain for several days with pain lasting on average 9 days. From day 1 postoperatively mild pain was experienced in the other surgical groups with the average duration of pain varying from 1 to 3 days depending on the surgery performed. Frequency of behavioral issues closely followed pain scores for each group. Analgesic prescribing and regimes at home varied widely, both within and between the different surgical groups. Rates of nausea and vomiting following discharge were low in all groups. The overall unplanned medical reattendance rate was 16%.
Adenotonsillectomy patients represent the biggest challenge in postoperative pain management of the head and neck surgeries evaluated. The low rates of pain, nausea, and vomiting reported in the days following surgery for the other procedures suggests that children can be cared for at home with simple analgesia. Discharge information and analgesia prescribing on discharge should be tailored to the operation performed.
腺样体扁桃体切除术后，儿童会在相当长的一段时间内经历剧烈疼痛，这一点已得到充分证实。然而，对于其他常见的头颈手术术后疼痛情况，人们了解较少。
本研究旨在描述接受择期头颈手术的儿童术后疼痛的严重程度和持续时间（主要结果）。还对行为障碍、恶心呕吐、家长满意度和再次就医率进行了测量（次要结果）。
邀请接受常见头颈手术的儿童（0至18岁）的家长参与。通过多次电话访谈收集手术当天及出院后每天的疼痛评分。收集的数据包括疼痛程度、开具和使用的镇痛药、行为障碍发生率以及恶心呕吐评分。随访持续至疼痛缓解。
对251例患者进行了分析（50例行腺样体切除术，51例行腺样体扁桃体切除术，19例行鼓膜成形术，52例行鼓膜切开术，43例行斜视手术，36例行舌系带切开术）。手术当天，鼓膜成形术、斜视手术和腺样体扁桃体切除术患者平均有中度疼痛，而腺样体切除术、舌系带切开术和鼓膜切开术患者有轻度疼痛。腺样体扁桃体切除术患者持续数天有中度疼痛，疼痛平均持续9天。术后第1天起，其他手术组患者经历轻度疼痛，疼痛平均持续时间根据所进行的手术不同在1至3天之间。每组行为问题的发生率与疼痛评分密切相关。不同手术组内部和之间，家庭镇痛药物的开具和使用方案差异很大。所有组出院后恶心呕吐发生率都很低。总体非计划再次就医率为16%。
在评估的头颈手术中，腺样体扁桃体切除术患者在术后疼痛管理方面构成最大挑战。其他手术术后数天报告的疼痛、恶心和呕吐发生率较低，这表明儿童使用简单镇痛药即可在家中得到照料。出院信息和出院时镇痛药的开具应根据所进行的手术进行调整。
