Gee Kristin M, Jones R Ellen, Nevarez Nicole, McClain Lauren E, Wools Gentry, Beres Alana L
Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390.
Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390.
J Pediatr Surg. 2020 Jun;55(6):1043-1047. doi: 10.1016/j.jpedsurg.2020.02.051. Epub 2020 Feb 27.
Opiates are often prescribed after pediatric operations despite safety concerns and lack of evidence confirming superiority compared to other pain control modalities. In this study, we use daily parental surveys to prospectively evaluate a strict non-opioid pain control strategy after laparoscopic appendectomy.
After IRB approval, children who underwent laparoscopic appendectomy for nonperforated acute appendicitis were recruited to the study. For these patients, our standard practice is to provide instructions to administer alternating acetaminophen and ibuprofen over-the-counter (OTC) postoperatively, and no opiate prescriptions are written. Parents of enrolled children received a daily RedCap survey via text message or e-mail on postoperative days (POD) 1 through 5 to prospectively assess pain control and medication usage. Trends were compared across postoperative days.
One hundred twenty patients were enrolled in the study, and none received opiate prescriptions. Postoperative pain survey response rates were 54% on POD1, 47% on POD2, 35% on POD3, 34% on POD4, and 29% on POD5. Pain level was 4.7 ± 2.3 (out of 10) on POD1, and down-trended significantly each postoperative day to reach 0.7 ± 1.2 by POD5. On POD1, 85% of parents administered OTC medications, which reduced significantly to 14% by POD5. Parent-reported success rates to manage pain by OTC regimen were 85% on POD1, 94% on POD2, 91% on POD3, and 100% on POD4 and POD5.
Strict non-opioid pain control after appendectomy exhibits high performance based upon prospective parental surveys. This strategy should be implemented as standard of care and tested for application to other surgical conditions.
Level II.
尽管存在安全担忧且缺乏证据证实与其他疼痛控制方式相比具有优越性，但儿科手术后仍经常开具阿片类药物处方。在本研究中，我们通过每日家长调查问卷，对腹腔镜阑尾切除术后严格的非阿片类疼痛控制策略进行前瞻性评估。
经机构审查委员会（IRB）批准，招募因非穿孔性急性阑尾炎接受腹腔镜阑尾切除术的儿童参与本研究。对于这些患者，我们的标准做法是术后指导家长交替使用对乙酰氨基酚和布洛芬非处方药（OTC），且不开具阿片类药物处方。入组儿童的家长在术后第1天至第5天通过短信或电子邮件收到每日的RedCap调查问卷，以前瞻性评估疼痛控制和药物使用情况。比较术后各天的趋势。
120例患者入组本研究，无一例接受阿片类药物处方。术后疼痛调查的回复率在术后第1天为54%，第2天为47%，第3天为35%，第4天为34%，第5天为29%。术后第1天疼痛评分为4.7±2.3（满分10分），术后每天显著下降，至术后第5天降至0.7±1.2。术后第1天，85%的家长使用了OTC药物，至术后第5天显著降至14%。家长报告的通过OTC方案控制疼痛的成功率在术后第1天为85%，第2天为94%，第3天为91%，第4天和第5天为100%。
基于前瞻性家长调查，阑尾切除术后严格的非阿片类疼痛控制表现良好。该策略应作为护理标准实施，并测试其在其他手术情况中的应用。
二级。
