Sheridan David C, Hansen Matthew L, Lin Amber L, Fu Rongwei, Meckler Garth D
Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon.
Department of Pediatrics, Pediatric Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
J Emerg Med. 2018 May;54(5):600-606. doi: 10.1016/j.jemermed.2018.01.003. Epub 2018 Feb 15.
Migraine headaches are a common reason for pediatric emergency department (ED) visits. Small studies suggest the potential efficacy of sub-anesthetic doses of propofol for migraine with a favorable side effect profile and potentially decreased length of stay (LOS).
The objective of this study was to compare the efficacy of low-dose propofol (LDP) to standard therapy (ST) in pediatric migraine treatment.
We conducted a prospective, pragmatic randomized controlled trial from April 2014 through June 2016 in the ED at two pediatric hospitals. Patients aged 7-19 years were eligible if they were diagnosed with migraine by the emergency physician and had a presenting visual analog pain score (VAS) of 6-10. Primary outcome was the percent of pain reduction. Secondary outcomes were ED LOS, 24-h rebound headache, return visits to the ED, and adverse reactions.
Seventy-four patients were enrolled, but 8 were excluded, leaving 66 patients in the final analysis (36 ST, 30 LDP). Pain reduction was 59% for ST and 51% for LDP (p = 0.34) with 72.2% vs. 73.3% achieving a VAS ≤ 4 with initial therapy (p = 0.92). There was a nonsignificant trend toward shorter median LOS from drug administration to final disposition favoring propofol (79 min vs. 111 min; p = 0.09). Rebound headache was significantly more common in the ST vs. LDP group (66.7% vs. 25.0%; p = 0.01).
LDP did not achieve better pain reduction than ST, however, LDP was associated with significantly fewer rebound headaches and a nonsignificant trend toward shorter median LOS from drug administration to disposition.
偏头痛是儿科急诊科（ED）就诊的常见原因。小型研究表明，亚麻醉剂量的丙泊酚对偏头痛可能有效，副作用较小，且可能缩短住院时间（LOS）。
本研究的目的是比较低剂量丙泊酚（LDP）与标准治疗（ST）在儿科偏头痛治疗中的疗效。
2014年4月至2016年6月，我们在两家儿科医院的急诊科进行了一项前瞻性、实用性随机对照试验。年龄在7-19岁之间、经急诊医生诊断为偏头痛且视觉模拟疼痛评分（VAS）为6-10的患者符合入选标准。主要结局是疼痛减轻的百分比。次要结局包括急诊科住院时间、24小时后反弹性头痛、再次到急诊科就诊以及不良反应。
共纳入74例患者，但8例被排除，最终分析纳入66例患者（36例接受标准治疗，30例接受低剂量丙泊酚治疗）。标准治疗组疼痛减轻59%，低剂量丙泊酚治疗组疼痛减轻51%（p = 0.34），初始治疗时视觉模拟疼痛评分≤4的患者比例分别为72.2%和73.3%（p = 0.92）。从给药到最终出院，低剂量丙泊酚组的中位住院时间有缩短趋势，但差异无统计学意义（79分钟 vs. 111分钟；p = 0.09）。标准治疗组反弹性头痛的发生率显著高于低剂量丙泊酚组（66.7% vs. 25.0%；p = 0.01）。
低剂量丙泊酚在减轻疼痛方面并不优于标准治疗，然而，低剂量丙泊酚组反弹性头痛的发生率显著较低，且从给药到出院的中位住院时间有缩短趋势，但差异无统计学意义。
