Department of Otolaryngology, Cook Children's Hospital, 901 7th Avenue, 1st Floor, Fort Worth, TX 76104, United States of America.
Scope Anesthesia, Carolinas Medical Center/Levine Children's Hospital, 1000 Blythe Blvd, Charlotte, NC 28203, United States of America.
Am J Otolaryngol. 2019 Nov-Dec;40(6):102294. doi: 10.1016/j.amjoto.2019.102294. Epub 2019 Sep 9.
Postoperative pain control is of significant interest in pediatric otolaryngology given the safety concerns with opioid use. We sought to determine if addition of intraoperative intravenous acetaminophen decreases perioperative morphine use in pediatric tonsillectomy.
This study is a retrospective cohort study performed at a tertiary care academic children's hospital. 166 pediatric patients (aged 1-16 years) who underwent tonsillectomy with or without adenoidectomy were for review. Seventy-four patients received intraoperative intravenous acetaminophen (intervention cohort), while ninety-two patients served as our control and did not receive any intraoperative intravenous acetaminophen. Perioperative (intraoperative and postoperative) morphine use was our primary outcome measure. Rate of adverse events in the post anesthesia care unit and time for discharge readiness were secondary outcome measures. Wilcoxon two-sample t-test approximation and Fisher's exact test were used for data analyses.
Patients in the intravenous acetaminophen cohort received less morphine (mg/kg) intraoperatively (0.058 versus 0.070, p = 0.089) and in the post anesthesia care unit (0.034 versus 0.051, p = 0.034) than the control cohort. The median time to discharge readiness for the intravenous acetaminophen and control groups was 108.5 versus 105 min (p = 0.018). There was no adverse respiratory event (oxygen desaturation <92% lasting more than a minute, requiring bag mask ventilation or reintubation) in either group in the post anesthesia care unit. There were 5 (7%) episodes of postoperative vomiting in the IV APAP, while 2 (2%) were recorded in the control cohort (p = 0.244).
Our findings suggest intraoperative intravenous acetaminophen use in pediatric tonsillectomy can decrease the perioperative use of opioid for optimal pain management.
鉴于阿片类药物使用的安全性问题，小儿耳鼻喉科对外科手术后疼痛控制非常关注。本研究旨在确定术中静脉注射对乙酰氨基酚是否可以减少小儿扁桃体切除术围手术期吗啡的使用。
这是一项在三级儿科学术医院进行的回顾性队列研究。共回顾了 166 名（年龄 1-16 岁）接受扁桃体切除术加或不加腺样体切除术的小儿患者。74 例患者接受术中静脉注射对乙酰氨基酚（干预组），92 例患者作为对照组且未接受任何术中静脉注射对乙酰氨基酚。围手术期（术中及术后）吗啡使用是本研究的主要观察指标。麻醉后护理单元（PACU）中的不良事件发生率和出院准备时间是次要观察指标。Wilcoxon 两样本 t 检验逼近法和 Fisher 确切检验用于数据分析。
与对照组相比，静脉注射对乙酰氨基酚组患者术中（0.058 对 0.070，p=0.089）和 PACU 中（0.034 对 0.051，p=0.034）接受的吗啡（mg/kg）更少。静脉注射对乙酰氨基酚组和对照组患者达到出院准备时间中位数分别为 108.5 分钟和 105 分钟（p=0.018）。在 PACU 中，两组均无不良呼吸事件（血氧饱和度<92%持续 1 分钟以上，需要面罩通气或重新插管）。静脉注射对乙酰氨基酚组有 5 例（7%）术后呕吐，对照组有 2 例（2%）（p=0.244）。
我们的研究结果表明，小儿扁桃体切除术中静脉注射对乙酰氨基酚可减少围手术期阿片类药物的使用，以达到最佳的疼痛管理效果。
