Albert Einstein College of Medicine, Bronx, USA; Montefiore Medical Center, Department of Anesthesiology, USA.
Albert Einstein College of Medicine, Bronx, USA.
Int J Pediatr Otorhinolaryngol. 2021 Jan;140:110501. doi: 10.1016/j.ijporl.2020.110501. Epub 2020 Nov 27.
Opioids are administered during the intraoperative and postoperative periods in pediatric adenotonsillectomy and tonsillectomy. Non-opioid analgesics are often used as an analgesic during pediatric adenotonsillectomy and tonsillectomy. In this hypothesis generating study, we are evaluating safety and efficacy of stand-alone opioid analgesia for adenotonsillectomy and tonsillectomy.
This is a single-center retrospective chart review of patients ages 2 to 13 who underwent elective adenotonsillectomy and tonsillectomy. We used a convenience sampling method to select patients who received intraoperative intravenous fentanyl, acetaminophen, ibuprofen, or any combination thereof. The following outcomes were analyzed in this study: (i) the length of Post Anesthesia Care Unit stay, (ii) administration of postoperative opioids; (iii) postoperative opioid equivalents required; (iv) administration of postoperative non-opioid analgesics; and (v) inpatient admission from ED within 30 days. We used univariate analysis to compare the data points.
We analyzed data from 323 patients who underwent adenotonsillectomy and tonsillectomy. The Post Anesthesia Care Unit length stay was similar for the intraoperative opioid-free and intraoperative opioid groups, 146.68 (±67.35) and 143.18 (±37.85) minutes, respectively (p = 0.586). Additionally, 102 patients (73.4%) in the intraoperative opioid-free group and 184 patients (83.2%) in the intraoperative opioid group did not receive any postoperative opioids (p = 0.033). The incidence of adverse events was similar between the intraoperative opioid-free and intraoperative opioid groups 3 (2.2%) and 5 (2.7%) respectively, p-value 0.749. A subgroup analysis comparing extracapsular 235 (72.8%) versus intracapsular 88 (27.2%) tonsillectomy yielded similar results.
In this study, our data indicates that American Society of Anesthesiologists I- II pediatric patients undergoing adenotonsillectomy and tonsillectomy can be efficiently and safely managed with an opioid-free intraoperative and postoperative analgesic regimen. Due to the explained limitations, our study results should be interpreted cautiously.
在小儿腺样体扁桃体切除术和扁桃体切除术期间，会给予阿片类药物进行围手术期镇痛。非阿片类镇痛药通常在小儿腺样体扁桃体切除术和扁桃体切除术中用作镇痛药。在这项假设生成研究中，我们正在评估单独使用阿片类药物镇痛用于腺样体扁桃体切除术和扁桃体切除术的安全性和有效性。
这是一项对年龄在 2 至 13 岁之间接受择期腺样体扁桃体切除术和扁桃体切除术的患者进行的单中心回顾性图表审查。我们使用便利抽样法选择接受术中静脉内芬太尼、对乙酰氨基酚、布洛芬或其任意组合的患者。本研究分析了以下结果：（i）麻醉后护理病房的停留时间；（ii）术后阿片类药物的给予；（iii）术后需要的阿片类药物等效物；（iv）术后非阿片类镇痛药的给予；以及（v）30 天内从 ED 入院。我们使用单变量分析来比较数据点。
我们分析了 323 名接受腺样体扁桃体切除术和扁桃体切除术的患者的数据。术中无阿片类药物组和术中阿片类药物组的麻醉后护理病房停留时间相似，分别为 146.68（±67.35）和 143.18（±37.85）分钟（p=0.586）。此外，术中无阿片类药物组 102 名患者（73.4%）和术中阿片类药物组 184 名患者（83.2%）未接受任何术后阿片类药物（p=0.033）。术中无阿片类药物组和术中阿片类药物组的不良事件发生率相似，分别为 3（2.2%）和 5（2.7%），p 值为 0.749。对比较包膜外 235 例（72.8%）和包膜内 88 例（27.2%）扁桃体切除术的亚组分析得出了类似的结果。
在这项研究中，我们的数据表明，美国麻醉师协会 I-II 级小儿腺样体扁桃体切除术和扁桃体切除术患者可以通过无阿片类药物的围手术期镇痛方案进行有效和安全的管理。由于存在解释性限制，我们的研究结果应谨慎解读。
