Jia Yingping, Zhou Rui, Li Zhengchen, Wang Yuanyuan, Chen Sandong, Zhao Liyuan, Shao Yi, Qi Jinlian
Department of Anesthesiology, Children's Hospital of Henan, Zhengzhou, China.
Front Pharmacol. 2022 May 5;13:908212. doi: 10.3389/fphar.2022.908212. eCollection 2022.
Tonsillectomy is a frequently performed surgical procedure in children, requiring post-operative analgesia. This study evaluated the efficacy and safety of nalbuphine or sufentanil combined with dexmedetomidine for patient-controlled intravenous analgesia (PCIA) after pediatric tonsillectomy adenoidectomy. A total of 400 patients undergoing tonsillectomy with and without adenoidectomy were included in the study. Patients received a PCIA pump (0.5 mg/kg nalbuphine, 2 μg/kg dexmedetomidine and 0.9% sodium chloride to a total volume of 100 ml) for postoperative pain management were classified into Group ND (n = 200). Patients received a PCIA pump (2 μg/kg sufentanil, 2 μg/kg dexmedetomidine and 0.9% sodium chloride to a total volume of 100 ml) for postoperative pain management were classified into Group SD (n = 200). More stable hemodynamic changes were noted in Group ND than Group SD from 1 h to 48 h after operation. At 6, 12, 24, and 48 h after operation, the children in Group ND had higher Ramsay sedation scores than those in Group SD. The times to push the PCIA button in Group ND and Group SD were 2.44 ± 0.74 and 2.62 ± 1.00, showing significant differences ( = 0.041). The VASR scores of children in Group ND were significantly lower within 6, 12, and 24 h than those in Group SD ( < 0.05). The VASC scores of children in Group ND were significantly lower within four time points (2, 6, 12, and 24 h) than those in Group SD ( < 0.05). At 1st day after surgery, the children in Group ND had lower levels of serum ACTH, IL-6, and COR levels than those in Group SD ( < 0.001). The incidence rates of nausea and vomiting, and pruritus were significantly higher in Group SD than Group ND (5.00% vs. 11.00%, = 0.028; 1.00% vs. 4.50%, = 0.032). The total incidence rate of adverse reactions was significantly higher in Group SD than Group ND (15.00% vs. 31.00%, = 0.0001). The study demonstrated that dexmedetomidine added to nalbuphine PCIA enhanced the analgesic effects, attenuated the postoperative pain, and reduced the stress response after pediatric tonsillectomy adenoidectomy.
扁桃体切除术是儿童中经常进行的外科手术，术后需要镇痛。本研究评估了纳布啡或舒芬太尼联合右美托咪定用于小儿扁桃体切除腺样体切除术后患者自控静脉镇痛（PCIA）的有效性和安全性。共有400例接受或未接受腺样体切除术的扁桃体切除术患者纳入研究。接受PCIA泵（0.5mg/kg纳布啡、2μg/kg右美托咪定和0.9%氯化钠，总体积100ml）进行术后疼痛管理的患者被分为ND组（n = 200）。接受PCIA泵（2μg/kg舒芬太尼、2μg/kg右美托咪定和0.9%氯化钠，总体积100ml）进行术后疼痛管理的患者被分为SD组（n = 200）。术后1小时至48小时，ND组的血流动力学变化比SD组更稳定。术后6、12、24和48小时，ND组儿童的Ramsay镇静评分高于SD组。ND组和SD组按压PCIA按钮的次数分别为2.44±0.74和2.62±1.00，差异有统计学意义（P = 0.041）。ND组儿童在6、12和24小时内的VASR评分显著低于SD组（P < 0.05）。ND组儿童在四个时间点（2、6、12和24小时）的VASC评分显著低于SD组（P < 0.05）。术后第1天，ND组儿童的血清促肾上腺皮质激素、白细胞介素-6和皮质醇水平低于SD组（P < 0.001）。SD组恶心呕吐和瘙痒的发生率显著高于ND组（5.00%对11.00%，P = 0.028；1.00%对4.50%，P = 0.032）。SD组不良反应的总发生率显著高于ND组（15.00%对31.00%，P = 0.0001）。该研究表明，在纳布啡PCIA中加入右美托咪定可增强镇痛效果，减轻小儿扁桃体切除腺样体切除术后的疼痛，并降低应激反应。
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