Scottish Rite Hospital, Children's Healthcare of Atlanta, Atlanta, GA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.
Scottish Rite Hospital, Children's Healthcare of Atlanta, Atlanta, GA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.
J Perianesth Nurs. 2022 Oct;37(5):626-631. doi: 10.1016/j.jopan.2021.11.011. Epub 2022 Mar 5.
To examine the effects of preoperative gabapentin administration on postoperative pain in pediatric patients undergoing tonsillectomy/adenoidectomy (T/A) in a single ambulatory surgery location within a pediatric healthcare organization.
This randomized, controlled pilot study enrolled patients age 3-18 years with American Society of Anesthesiologists (ASA) scores of I-II undergoing T/A.
Both gabapentin and placebo groups were given study medication preoperatively and received standard opiate regimens intraoperatively and postoperative pain instructions. Outcome measurements included: time to first analgesic medication in the postanesthesia care unit (PACU), mean acetaminophen, ibuprofen, and opiate doses in mg/kg. Additionally, we examined pain scores, medication use, and side effects reported by daily pain diaries completed by patients/families for 3 days postoperatively.
Forty-nine patients were included in final analysis (gabapentin n = 26, placebo n = 23). Demographic and clinical characteristics of both groups were similar; the majority (46 of 49) were under the age of 13. Both groups received opiates in PACU. Some patients in both groups received hydrocodone/acetaminophen postoperatively. There were no reported differences in side effects between groups. Gabapentin group reported less use of opiates, acetaminophen, and ibuprofen post-discharge. We identified small effect sizes for opiates and acetaminophen, and medium effect size for ibuprofen (80.1% gabapentin versus 100% placebo, RR 0.81 [95% CI 0.67-0.97]). Median pain scores were 4 on a scale of 10 for both groups for all 3 days of follow-up. Overall median satisfaction score was 9, with a mean difference of 0.35 (95% CI -0.78 - 1.37). Analysis of variance revealed no difference in pain scores or satisfaction per pain diaries between the groups in general and no difference in score trajectory.
We were able to establish a rigorous process and feasibility to launch a larger, multi-center trial to examine this important issue. There remain few evidence-based options for acute pain relief in pediatric surgical populations besides opiates Identifying opiate alternatives that are effective, cost efficient and safe are needed for pediatric tonsillectomy patients.
在一家儿科医疗机构的单一门诊手术部位，研究术前给予加巴喷丁对行扁桃体切除术/腺样体切除术（T/A）的儿科患者术后疼痛的影响。
这是一项随机、对照的初步研究，纳入了年龄在 3-18 岁、美国麻醉医师学会（ASA）评分 I-II 级的 T/A 患者。
加巴喷丁组和安慰剂组均在术前给予研究药物，并在术中和术后疼痛指导下给予标准阿片类药物方案。结果测量包括：在麻醉后护理单元（PACU）中首次使用镇痛药的时间、平均对乙酰氨基酚、布洛芬和阿片类药物剂量（mg/kg）。此外，我们还通过患者/家属术后 3 天完成的每日疼痛日记，检查了术后疼痛评分、药物使用情况和不良反应。
49 例患者最终纳入分析（加巴喷丁组 n=26，安慰剂组 n=23）。两组患者的人口统计学和临床特征相似；大多数（49 例中的 46 例）年龄小于 13 岁。两组患者在 PACU 中均接受了阿片类药物。两组均有一些患者术后接受了氢可酮/对乙酰氨基酚。两组之间无不良反应差异报告。加巴喷丁组出院后阿片类药物、对乙酰氨基酚和布洛芬的使用量较少。我们发现阿片类药物和对乙酰氨基酚的效应量较小，而布洛芬的效应量中等（80.1%的加巴喷丁与 100%的安慰剂，RR 0.81[95%CI 0.67-0.97]）。两组在所有 3 天的随访中，疼痛评分中位数均为 4（评分范围为 10）。总体满意度中位数为 9，平均差异为 0.35（95%CI -0.78 - 1.37）。方差分析显示，两组患者在一般情况下的疼痛评分和满意度无差异，且评分轨迹也无差异。
我们能够建立一个严格的流程，并为开展一项更大的、多中心试验以研究这个重要问题奠定了基础。除了阿片类药物之外，儿科手术人群的急性疼痛缓解几乎没有其他基于证据的选择。对于接受扁桃体切除术的儿科患者来说，需要寻找有效、经济高效且安全的阿片类药物替代品。
