Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Canada.
Department of Anesthesiology and Pain Management, Hospital for Sick Children and University of Toronto, Toronto, Canada.
J Pediatr Urol. 2018 Apr;14(2):171.e1-171.e6. doi: 10.1016/j.jpurol.2017.11.014. Epub 2018 Jan 31.
There are limited data about pain patterns, analgesic requirements and factors predicting opioid requirements of children undergoing outpatient urologic surgery. This prospective study aimed to assess recovery profiles and pain medication requirements.
Patients between 6 months and 12 years of age were recruited prospectively between December 2013 and June 2014. Demographic and operative characteristics were collected. Following discharge home, the parents were asked to administer both acetaminophen and ibuprofen Q6H at a weight-adjusted dose, based on a schedule, until the end of postoperative day 2, and to administer the medication as required on postoperative day 3. Pain severity was recorded using validated pain scores (Face, Legs, Activity, Cry, Consolability/Parents' Postoperative Pain Measurement). A morphine prescription was provided for breakthrough pain. A Likert scale was used to assess parent's satisfaction with the pain management.
A total of 249 patients were recruited, 111 patients (45%) returned appropriately completed surveys and were included in the final analysis. Mean age was 44.1 months (SD = 37.3). The performed procedures were orchidopexy (31), hypospadias repair (26), hernia/hydrocele repair (15), Fowler-Stephens procedure (13), meatoplasty (7), phalloplasty (4), scrotoplasty (1), circumcision (7), and diagnostic laparoscopy (5). After discharge home 17 patients (15.3%) received morphine. Mean utilization of non-opioid analgesia was 79% on postoperative day 1, 67% on day 2, 36% on day 3, and 2% on day 4. Parental satisfaction was high (92.0% satisfied/very satisfied). No patient, anaesthetic or surgical factors were associated with opioid use or prolonged need for postoperative analgesia.
The combination of scheduled non-opioid medications for maintenance and opioids for breakthrough pain provided satisfactory pain control after outpatient urologic surgery in children. There were no specific patient, anesthetic or surgical factors that predicted postoperative opioid requirements.
关于接受门诊泌尿外科手术的儿童的疼痛模式、镇痛需求和预测阿片类药物需求的因素，相关数据有限。本前瞻性研究旨在评估恢复情况和疼痛药物需求。
2013 年 12 月至 2014 年 6 月期间，前瞻性招募了 6 个月至 12 岁的患儿。收集了人口统计学和手术特征。患儿出院回家后，父母根据时间表按体重调整剂量给予对乙酰氨基酚和布洛芬，每 6 小时一次，持续到术后第 2 天结束，术后第 3 天按需给予药物。疼痛严重程度采用经验证的疼痛评分（面部、腿部、活动、哭泣、安抚/父母术后疼痛测量）进行记录。提供了吗啡处方用于缓解突破性疼痛。采用李克特量表评估父母对疼痛管理的满意度。
共招募了 249 例患儿，111 例患儿（45%）返回了完整的调查问卷，纳入最终分析。平均年龄为 44.1 个月（SD=37.3）。进行的手术包括睾丸固定术（31 例）、尿道下裂修复术（26 例）、疝/鞘膜积液修复术（15 例）、Fowler-Stephens 手术（13 例）、会阴成形术（7 例）、阴茎成形术（4 例）、阴囊成形术（1 例）、包皮环切术（7 例）和诊断性腹腔镜检查（5 例）。出院回家后，17 例患儿（15.3%）接受了吗啡。术后第 1 天非阿片类镇痛药物的平均使用率为 79%，第 2 天为 67%，第 3 天为 36%，第 4 天为 2%。家长满意度高（92.0%满意/非常满意）。没有患者、麻醉或手术因素与阿片类药物使用或术后镇痛需求延长相关。
门诊泌尿外科手术后，维持使用计划中的非阿片类药物和按需使用阿片类药物可提供满意的疼痛控制。没有特定的患者、麻醉或手术因素可以预测术后阿片类药物的需求。
