Walrave Y, Maschi C, Bailleux S, Falk A T, Hayem C, Carles M, De la Brière F
Department of Anesthesiology, Fondation Lenval, Nice, France.
Department of Otorhinolaryngology, Fondation Lenval, Nice, France.
Eur Arch Otorhinolaryngol. 2018 Jan;275(1):281-286. doi: 10.1007/s00405-017-4788-0. Epub 2017 Oct 27.
Tonsillectomy is one of the most common major surgical procedures performed in children. In 2013, the use of codeine in children was severely restricted. French guidelines for treating tonsillectomy's postoperative pain at home have been reconsidered OBJECTIVE: The aim of our study was to measure effectiveness and safety of two schedules: acetaminophen + ibuprofen (A + I) and acetaminophen + tramadol (A + T) in children who underwent tonsillectomy.
We undertook a 1 year prospective and observational single-center study. All children who underwent tonsillectomy were eligible. The choice of the regimen, A + I group or A + T group, was left for the anesthesiologist in charge, done during the pre-anesthetic assessment. After hospital discharge, parents had to give systematically A + I or A + T, 4 times a day during 5 days and then acetaminophen alone for the next 5 days The primary endpoint was the home pain assessed using Parents' Postoperative Pain Measurement Short Form (PPPM-SF) scale. Secondary endpoints were the rate of further hospitalization and/or surgery due to tonsillectomy-related adverse events.
Over the study period, 342 tonsillectomies were performed. The return rate of PPPM-SF scales was 58%. Two hundred patients were analyzed. The median age was 4 [3; 5.2] years and was lower in group A + I (4 [3; 5]; 5 [4; 7]; p < 0.0001). PPPM-SF scores were greater than or equal to 3 in both groups during the first 6 postoperative days. The mean decrease of PPPM-SF score over time was higher in group A + I than in group A + T (p = 0.007). Readmission rate was significantly higher in group A + T (A + I: 0; A + T: 7; p = 0.002) as the rate of reoperation for bleeding (A + I: 0; A + T: 3; p = 0.049).
Home pain management after tonsillectomy should be improved. In clinical practice, A + I seems at least as effective as the combination A + T, without increasing readmission and/or additional surgery for bleeding.
扁桃体切除术是儿童最常见的大型外科手术之一。2013年，儿童使用可待因受到严格限制。法国关于在家治疗扁桃体切除术后疼痛的指南已被重新审视。目的：我们研究的目的是衡量对乙酰氨基酚+布洛芬（A+I）和对乙酰氨基酚+曲马多（A+T）两种用药方案在接受扁桃体切除术儿童中的有效性和安全性。
我们进行了一项为期1年的前瞻性单中心观察性研究。所有接受扁桃体切除术的儿童均符合条件。用药方案的选择，即A+I组或A+T组，由负责的麻醉师在麻醉前评估时决定。出院后，家长必须在5天内每天4次系统性地给予A+I或A+T，然后在接下来的5天仅给予对乙酰氨基酚。主要终点是使用家长术后疼痛测量简表（PPPM-SF）评估的家庭疼痛。次要终点是因扁桃体切除术相关不良事件导致的再次住院和/或手术率。
在研究期间，共进行了342例扁桃体切除术。PPPM-SF量表的回收率为58%。对200例患者进行了分析。中位年龄为4[3；5.2]岁，A+I组年龄更小（4[3；5]；5[4；7]；p<0.0001）。术后前6天两组的PPPM-SF评分均大于或等于3。A+I组PPPM-SF评分随时间的平均下降幅度高于A+T组（p=0.007）。A+T组的再入院率显著更高（A+I组：0；A+T组：7；p=0.002），因出血再次手术的发生率也是如此（A+I组：0；A+T组：3；p=0.049）。
扁桃体切除术后的家庭疼痛管理应得到改善。在临床实践中，A+I似乎至少与A+T联合用药一样有效，且不会增加再次住院和/或因出血进行额外手术的风险。
