Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of BioMedical Research, University of Bern, Bern, Switzerland.
Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Br J Anaesth. 2021 Jun;126(6):1182-1191. doi: 10.1016/j.bja.2020.12.047. Epub 2021 Mar 5.
Insufficiently treated pain after paediatric appendectomy and tonsillectomy is frequent. We aimed to identify variables associated with poor patient-reported outcomes.
This analysis derives from the European PAIN OUT infant registry providing information on perioperative pharmacological data and patient-reported outcomes 24 h after surgery. Variables associated with the endpoint 'desire for more pain treatment' were evaluated by elastic net regularisation (odds ratio [95% confidence interval]).
Data from children undergoing appendectomy (n=472) and tonsillectomy (n=466) between 2015 and 2019 were analysed. Some 24.8% (appendectomy) and 20.2% (tonsillectomy) wished they had received more pain treatment in the 24 h after surgery. They reported higher composite pain scores (5.2 [4.8-5.5] vs 3.6 [3.5-3.8]), more pain-related interference, and more adverse events than children not desiring more pain treatment, and they received more opioids after surgery (morphine equivalents (81 [60-102] vs 50 [43-56] μg kg). Regression analysis revealed that pain-related sleep disturbance (appendectomy odds ratio: 2.8 [1.7-4.6], tonsillectomy 3.7 [2.1-6.5]; P<0.001) and higher pain intensities (1.5-fold increase) increased the probability of desiring more pain treatment. There was an inverse association between the number of different classes of non-opioids administered preventively, and the desire for more analgesics postoperatively. Children not receiving any non-opioid analgesics before the end of a tonsillectomy had a 3.5-fold (2.1-6.5-fold) increase in the probability of desiring more pain treatment, compared with children receiving at least two classes of different non-opioid analgesics.
Preventive administration of at least two classes of non-opioid analgesics is a simple strategy and may improve patient-reported outcomes.
小儿阑尾切除术和扁桃体切除术术后疼痛治疗不足的情况较为常见。我们旨在确定与较差的患者报告结局相关的变量。
本分析源自欧洲 PAIN OUT 婴儿登记处，提供了围手术期药理学数据和术后 24 小时患者报告结局的信息。通过弹性网络正则化（比值比[95%置信区间]）评估与终点“希望接受更多疼痛治疗”相关的变量。
对 2015 年至 2019 年间行阑尾切除术（n=472）和扁桃体切除术（n=466）的儿童进行了数据分析。术后 24 小时内，分别有 24.8%（阑尾切除术）和 20.2%（扁桃体切除术）的患儿希望接受更多的疼痛治疗。与未希望接受更多疼痛治疗的患儿相比，他们报告的复合疼痛评分更高（5.2[4.8-5.5]比 3.6[3.5-3.8]），疼痛相关干扰更多，不良事件更多，术后接受的阿片类药物也更多（吗啡当量（81[60-102]比 50[43-56]μg/kg）。回归分析显示，疼痛相关睡眠障碍（阑尾切除术的比值比：2.8[1.7-4.6]，扁桃体切除术 3.7[2.1-6.5]；P<0.001）和更高的疼痛强度（增加 1.5 倍）增加了希望接受更多疼痛治疗的可能性。预防使用的不同类别的非阿片类药物数量与术后对更多镇痛药物的需求呈反比关系。与接受至少两种不同类别的非阿片类镇痛药物的患儿相比，扁桃体切除术结束时未接受任何非阿片类镇痛药物治疗的患儿，希望接受更多疼痛治疗的可能性增加了 3.5 倍（2.1-6.5 倍）。
预防性使用至少两种类别的非阿片类镇痛药物是一种简单的策略，可能会改善患者报告的结局。
