Adler Adam C, Mehta Deepak K, Messner Anna H, Salemi Jason L, Chandrakantan Arvind
Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, USA; Baylor College of Medicine, USA.
Department of Otolaryngology; Baylor College of Medicine, USA; Department of Pediatric Otolaryngology; Texas Children's Hospital, USA; Baylor College of Medicine, USA.
Int J Pediatr Otorhinolaryngol. 2020 Jul;134:110045. doi: 10.1016/j.ijporl.2020.110045. Epub 2020 Apr 10.
Postoperative prescribing of opioids following pediatric adenotonsillectomy can have negative consequences including unnecessary opioid exposure and potential for respiratory depression. While guidelines from The American Academy of Otolaryngology/Head & Neck Surgery recommend treatment of post adenotonsillectomy pain using acetaminophen and ibuprofen, many providers continue to prescribe opioids and may do so, in part with concern for parental dissatisfaction with post-operative analgesia. Our aim was to determine whether a post-operative prescription for opioids affects parental assessment of pain control following pediatric adenotonsillectomy.
This post-operative survey assessed the parental assessment of pain control in 324 patients, ages 1-17 years undergoing adenotonsillectomy. This study was conducted at a quaternary care children's hospital in Houston, Texas from December 1, 2018 through March 31, 2019. Post-operative pain regimens included acetaminophen and ibuprofen or combination hydrocodone/acetaminophen in addition to ibuprofen for post-operative analgesia based on the attending surgeons prescribing preferences. The primary study outcome was identification of the proportion of parents rating their child's analgesia following pediatric adenotonsillectomy as poor or inadequate based on the post-operative analgesic regimen including opioids.
Of the 798 surveys sent, the response rate was 42% (324/775) of those who received the survey email, and 69% (324/470) for those who opened the email. Between the opioid and non-opioid groups, there was no difference in gender (male; 48% vs. 51.3%; p = 0.58), race/ethnicity (white; 53% vs. 46%; p = 0.35) or insurance status (insured; 62% vs. 50.9%; p = 0.06). The proportion of parents who rated their child's pain as poor or inadequately controlled following adenotonsillectomy was relatively rare: 9% and 5% in the non-opioid and opioid groups, respectively. Parents rating their child's pain as excellent with regards to pain control following adenotonsillectomy were 58% and 50% in the non-opioids and opioid groups respectively.
The results of this study indicate that non-opioid analgesic regimens following pediatric adenotonsillectomy were not associated with decreased parental satisfaction or an increasing assessment of poor or inadequately controlled pain. Limiting opioid exposure following pediatric adenotonsillectomy is feasible and does not result in worse parental satisfaction with the analgesic plan.
小儿腺样体扁桃体切除术后开具阿片类药物处方可能会产生负面影响，包括不必要的阿片类药物暴露以及呼吸抑制的可能性。虽然美国耳鼻咽喉头颈外科学会的指南建议使用对乙酰氨基酚和布洛芬治疗腺样体扁桃体切除术后疼痛，但许多医疗服务提供者仍继续开具阿片类药物，部分原因可能是担心家长对术后镇痛不满意。我们的目的是确定阿片类药物的术后处方是否会影响家长对小儿腺样体扁桃体切除术后疼痛控制的评估。
这项术后调查评估了324名年龄在1至17岁接受腺样体扁桃体切除术患者的家长对疼痛控制的评估。本研究于2018年12月1日至2019年3月31日在德克萨斯州休斯顿的一家四级护理儿童医院进行。术后疼痛治疗方案包括对乙酰氨基酚和布洛芬，或根据主刀医生的处方偏好，在使用布洛芬进行术后镇痛的基础上联合使用氢可酮/对乙酰氨基酚。主要研究结果是根据包括阿片类药物在内的术后镇痛方案，确定将小儿腺样体扁桃体切除术后孩子的镇痛效果评为差或不足的家长比例。
在发送的798份调查问卷中，收到调查问卷邮件的人的回复率为42%（324/775），打开邮件的人的回复率为69%（324/470）。阿片类药物组和非阿片类药物组在性别（男性；48%对51.3%；p = 0.58）、种族/民族（白人；53%对46%；p = 0.35）或保险状况（参保；62%对50.9%；p = 0.06）方面没有差异。将腺样体扁桃体切除术后孩子的疼痛评为控制不佳或不足的家长比例相对较低：非阿片类药物组和阿片类药物组分别为9%和5%。将腺样体扁桃体切除术后孩子的疼痛控制评为优秀的家长在非阿片类药物组和阿片类药物组中分别为58%和50%。
本研究结果表明，小儿腺样体扁桃体切除术后的非阿片类镇痛方案与家长满意度降低或对疼痛控制不佳或不足的评估增加无关。限制小儿腺样体扁桃体切除术后的阿片类药物暴露是可行的，并且不会导致家长对镇痛方案的满意度降低。
