Alghamdi Faris, Roth Catherine, Jatana Kris R, Elmaraghy Charles A, Rice Julie, Tobias Joseph D, Thung Arlyne K
Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus, OH, USA.
Department of Otolaryngology and Head & Neck Surgery, Nationwide Children's Hospital and the Ohio State University, Columbus, OH, USA.
J Pain Res. 2020 Nov 19;13:2997-3004. doi: 10.2147/JPR.S281275. eCollection 2020.
An opioid-sparing anesthetic involves a multi-modal technique with non-opioid medications targeting different analgesic pathways. Such techniques may decrease adverse effects related to opioids. These techniques may be considered in patients at higher risk for opioid-related adverse effects including obstructive sleep apnea or sleep disordered breathing.
A prospective, pilot study was performed in 10 patients (3-8 years of age), presenting for adenoidectomy. The perioperative regimen included oral dextromethorphan (1 mg/kg) and acetaminophen (15 mg/kg) plus single boluses of intraoperative dexmedetomidine (0.5 μg/kg) and ketamine (0.5 mg/kg). Pain scores were assessed in the post anesthesia care unit (PACU) using the FLACC (Face, Legs, Activity, Cry, Consolability) scale. Patients with a pain score >4 received fentanyl as needed. PACU time, pain scores, and parent satisfaction were recorded. Postoperatively, patients were instructed to use oral acetaminophen or ibuprofen every 6 hours as needed for pain.
The study cohort included 10 patients, 3-8 years of age. All patients had opioid-free anesthetic care. PACU time ranged from 24 to 102 minutes (median: 56 minutes). FLACC pain scores were 0 for all PACU assessments. Nine patients were discharged home and 1 patient had a planned overnight admission. Following hospital discharge, the pain scores were satisfactory during the 72-hour study period and 90% of the patients' guardians were satisfied or highly satisfied with their child's pain control.
This opioid-sparing approach provided safe and effective pain control as well as parental satisfaction following adenoidectomy in children. Additional prospective studies are needed to determine whether this regimen is effective in a larger cohort of patients with and for other otolaryngology procedures.
阿片类药物节省麻醉涉及一种多模式技术，使用针对不同镇痛途径的非阿片类药物。此类技术可能会减少与阿片类药物相关的不良反应。对于阿片类药物相关不良反应风险较高的患者，包括阻塞性睡眠呼吸暂停或睡眠呼吸紊乱患者，可考虑采用这些技术。
对10例（3至8岁）因腺样体切除术就诊的患者进行了一项前瞻性试点研究。围手术期方案包括口服右美沙芬（1mg/kg）和对乙酰氨基酚（15mg/kg），术中单次推注右美托咪定（0.5μg/kg）和氯胺酮（0.5mg/kg）。在麻醉后护理单元（PACU）使用FLACC（面部、腿部、活动、哭闹、安慰度）量表评估疼痛评分。疼痛评分>4的患者按需给予芬太尼。记录PACU停留时间、疼痛评分和家长满意度。术后，指导患者按需每6小时口服对乙酰氨基酚或布洛芬以缓解疼痛。
研究队列包括10例3至8岁的患者。所有患者均接受了无阿片类药物的麻醉护理。PACU停留时间为24至102分钟（中位数：56分钟）。所有PACU评估的FLACC疼痛评分为0。9例患者出院回家，1例患者计划过夜住院。出院后，在72小时的研究期间疼痛评分令人满意，90%的患者监护人对其孩子的疼痛控制感到满意或非常满意。
这种阿片类药物节省方法在儿童腺样体切除术后提供了安全有效的疼痛控制以及家长满意度。需要更多的前瞻性研究来确定该方案在更大的患者队列中以及对于其他耳鼻喉科手术是否有效。
