Hong Boohwi, Lim Chae Seong, Kim Yoon-Hee, Lee Jung Un, Kim Yong Min, Jung Choonho, Jo Yumin
Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University Hospital, Daejeon, Korea.
J Anesth. 2017 Aug;31(4):559-564. doi: 10.1007/s00540-017-2353-z. Epub 2017 Apr 13.
Tonsillectomy in pediatric patients may cause severe postoperative pain. Topical local anesthetics are an easy and safe way to control post-tonsillectomy pain, but there is no benefit during the early postoperative stage. Topical ketamine shows a good effect on early stage postoperative pain. We compared the effect of topical ropivacaine with and without ketamine on post-tonsillectomy pain.
Patients aged 3-7 years undergoing tonsillectomy were selected to participate in the study. Our study was performed in a randomized, placebo-controlled, double-blind manner. Patients were randomly assigned to one of two groups using computer-generated random numbers. The researchers who assessed the pain score, the caregivers, and the patient were blinded to group assignment. One group received topical ropivacaine with saline (RS group) and the other group received topical ropivacaine with 20 mg ketamine (RK group) on the tonsillar bed. Pain scores using the modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) at 15 min and 30 min, and at 1, 2, 4, 8, 16 and 24 h were recorded. Rescue analgesic requirement and complications were also recorded.
A total of 66 patients were randomly assigned to the RS group (n = 33) and the RK group (n = 33). The mCHEOPS scores were significantly lower in the RK group at 15 min (P = 0.046). The mCHEOPS scores of the two groups decreased with time, but there was no intergroup interaction. The RS group received more analgesics until 1 h after surgery and the RK group received more analgesics during 1-24 h after surgery. There were no differences in adverse outcomes.
Topical ropivacaine with ketamine can reduce immediate postoperative pain and analgesic requirement better than ropivacaine alone.
小儿扁桃体切除术可能导致严重的术后疼痛。局部外用麻醉剂是控制扁桃体切除术后疼痛的一种简便且安全的方法，但在术后早期并无益处。外用氯胺酮对术后早期疼痛显示出良好效果。我们比较了含与不含氯胺酮的外用罗哌卡因对扁桃体切除术后疼痛的影响。
选取年龄在3至7岁接受扁桃体切除术的患者参与本研究。我们的研究采用随机、安慰剂对照、双盲方式进行。使用计算机生成的随机数将患者随机分配至两组之一。评估疼痛评分的研究人员、护理人员及患者均对分组情况不知情。一组在扁桃体床接受含生理盐水的外用罗哌卡因（RS组），另一组接受含20毫克氯胺酮的外用罗哌卡因（RK组）。记录使用改良的安大略东部儿童医院疼痛量表（mCHEOPS）在15分钟和30分钟时以及1、2、4、8、16和24小时时的疼痛评分。还记录了急救镇痛药的使用需求及并发症情况。
共有66例患者被随机分配至RS组（n = 33）和RK组（n = 33）。RK组在15分钟时的mCHEOPS评分显著更低（P = 0.046）。两组的mCHEOPS评分均随时间下降，但不存在组间交互作用。RS组在术后1小时内接受了更多镇痛药，而RK组在术后1至24小时内接受了更多镇痛药。不良结局方面无差异。
与单独使用罗哌卡因相比，含氯胺酮的外用罗哌卡因能更好地减轻术后即刻疼痛及镇痛药需求。
