扁桃体切除术后的静脉注射吗啡镇痛——是否为时过晚或被夸大？

Analgesia after tonsillectomy with controlled intravenous morphine - overdue or exaggerated?

机构信息

Uniklinik Koeln, Department of Anaesthesiology and Intensive Care Medicine, Koeln, Germany; Malteser Waldkrankenhaus St. Marien, Department of Anaesthesiology and Intensive Care Medicine, Erlangen, Germany.

Uniklinik Koeln, Department of Anaesthesiology and Intensive Care Medicine, Koeln, Germany; Uniklinik Koeln, Department of Palliative Medicine, Koeln, Germany.

出版信息

Braz J Otorhinolaryngol. 2023 Jan-Feb;89(1):48-53. doi: 10.1016/j.bjorl.2021.08.002. Epub 2021 Oct 18.

OBJECTIVE

To assess the value of a morphine Patient Controlled Intravenous Analgesia (PCIA) after Tonsillectomies (TE).

METHODS

30 adult patients were treated with oral analgesics (protocol group) and compared to 30 patients treated with a morphine PCIA for the first 3 Postoperative Days (PODs) after TE. Average and maximum pain severities (Numeric Rating Scale - NRS: 0-10) on PODs 1-3, analgesic score, quality of life, patient satisfaction and side effects were defined as outcome measures.

RESULTS

Average pain severities of the protocol and the PCIA group were of similar magnitude (NRS) (POD1: 4.48 vs. 4.71 [p = 0.68], POD2: 4.75 vs. 4.22 [p = 0.32] and POD3: 4.44 vs. 4.25 [p = 0.71]). Maximum pain intensities on POD1 (p = 0.92), POD2 (p = 0.51) and POD3 (p = 0.36) were also comparable between both groups. Patients with a PCIA consumed significantly more opioids (p = 0.001) without significant more side-effects.

CONCLUSION

The PCIA did not provide a superior pain control compared to oral analgesics. In view of the considerable effort and the high opioid consumption, it cannot be recommended as a standardized application for pain control after TE.

目的

评估扁桃体切除术后（TE）应用吗啡患者自控静脉镇痛（PCIA）的价值。

方法

30 例成人患者采用口服镇痛药（方案组）治疗，并与 30 例术后第 1-3 天应用吗啡 PCIA 的患者进行比较。术后第 1-3 天的平均和最大疼痛强度（数字评分量表-NRS：0-10）、镇痛评分、生活质量、患者满意度和副作用被定义为结局指标。

结果

方案组和 PCIA 组的平均疼痛强度（NRS）相似（POD1：4.48 比 4.71[P=0.68]，POD2：4.75 比 4.22[P=0.32]，POD3：4.44 比 4.25[P=0.71]）。两组患者在 POD1（P=0.92）、POD2（P=0.51）和 POD3（P=0.36）的最大疼痛强度也相似。PCIA 组患者使用的阿片类药物明显更多（P=0.001），但副作用无明显增加。