静脉注射地塞米松与局部麻醉浸润技术对儿童扁桃体切除术后恶心呕吐的影响：一项随机双盲临床试验。

The effect of IV dexamethasone versus local anesthetic infiltration technique in postoperative nausea and vomiting after tonsillectomy in children: A randomized double-blind clinical trial.

作者信息

Naja Zoher, Kanawati Saleh, Al Khatib Rania, Ziade Fouad, Naja Zeina Z, Naja Ahmad Salah, Rajab Mariam

机构信息

Anesthesia and Pain Management Department, Makassed General Hospital, Beirut, Lebanon.

出版信息

Int J Pediatr Otorhinolaryngol. 2017 Jan;92:21-26. doi: 10.1016/j.ijporl.2016.10.030. Epub 2016 Oct 28.

DOI:10.1016/j.ijporl.2016.10.030

PMID:28012528

Abstract

BACKGROUND

Local anesthetic infiltration and corticosteroids had shown effectiveness in reducing post tonsillectomy nausea, vomiting and pain.

OBJECTIVES

To compare the effect of intravenous dexamethasone versus pre-incision infiltration of local anesthesia in pediatric tonsillectomy on postoperative nausea and vomiting (PONV). The secondary objective was postoperative pain.

METHODS

A randomized double-blind clinical trial was conducted at a tertiary care teaching hospital. Children admitted to undergo tonsillectomy aged between 4 and 13 years from January 2015 to August 2015 were enrolled and divided into two groups. Both groups had general anesthesia. Group I received intravenous dexamethasone 0.5 mg/kg (maximum dose 16 mg) with placebo pre-incision infiltration. Group II received pre-incision infiltration a total of 2-4 ml local anesthesia mixture with saline and an equivalent volume of intravenous saline.

RESULTS

Group I consisted of 64 patients while group II had 65 patients. In the PACU, 15.6% of patients in group I experienced vomiting compared to 3.1% in group II (p-value = 0.032). After 24 h, the incidence of PONV was significantly higher in group I compared to group II (26.6% vs. 9.2% respectively, p-value = 0.019). At 48 h postoperatively, PONV was significantly higher in group I (p-value = 0.013). The incidence was similar in both groups after three, four and five postoperative days. Baseline pain and pain during swallowing were significantly different at 6, 12 and 24 h as well as days 1 through 5. Pain upon jaw opening was significantly different at 6, 12 and 24 h between the two groups. Pain while eating soft food was significantly different at 24 h and days 2 through 5. In the PACU, 20.3% of patients in group I received diclofenac compared to 3.1% in group II (p-value = 0.005). From day 1 till day 5, analgesic consumption was significantly higher in group I.

CONCLUSION

Local anesthetic infiltration in addition to NSAIDS and paracetamol could serve as a multimodal analgesia and decrease PONV.

TRIAL REGISTRATION

NCT02355678.

摘要

背景

局部麻醉药浸润和皮质类固醇已显示出在减轻扁桃体切除术后恶心、呕吐和疼痛方面的有效性。

目的

比较小儿扁桃体切除术中静脉注射地塞米松与切口前局部麻醉浸润对术后恶心和呕吐（PONV）的影响。次要目的是术后疼痛。

方法

在一家三级护理教学医院进行了一项随机双盲临床试验。纳入2015年1月至2015年8月入院接受扁桃体切除术的4至13岁儿童，并分为两组。两组均接受全身麻醉。第一组静脉注射地塞米松0.5mg/kg（最大剂量16mg），切口前浸润安慰剂。第二组切口前共浸润2 - 4ml局部麻醉混合液与生理盐水以及等量的静脉生理盐水。

结果

第一组有64例患者，第二组有65例患者。在麻醉后恢复室（PACU），第一组15.6%的患者出现呕吐，而第二组为3.1%（p值 = 0.032）。24小时后，第一组PONV的发生率显著高于第二组（分别为26.6%和9.2%，p值 = 0.019）。术后48小时，第一组的PONV发生率显著更高（p值 = 0.013）。术后第3、4和5天两组的发生率相似。术后6、12和24小时以及第1至5天的基线疼痛和吞咽时疼痛有显著差异。两组在术后6、12和24小时的张口疼痛有显著差异。术后24小时以及第2至5天吃软食时的疼痛有显著差异。在PACU，第一组20.3%的患者接受了双氯芬酸，而第二组为3.1%（p值 = 0.005）。从第1天到第5天，第一组的镇痛药物消耗量显著更高。