Department of Otorhinolaryngology, Steve Biko Academic Hospital, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Int J Pediatr Otorhinolaryngol. 2022 Oct;161:111260. doi: 10.1016/j.ijporl.2022.111260. Epub 2022 Aug 5.
Post-adenotonsillectomy pain is often severe, requiring substantial analgesia in the first 48-72 h. This pain is not only distressing to the patient and his or her parents, but often reflects poorly on an otherwise well performed procedure. Safe, simple and effective post-adenotonsillectomy pain control is still clinically elusive, even though a multitude of surgical and analgesic interventions have been proposed.
To investigate the analgesic properties of immediate post-operative application of xylocaine 10% pump spray to the tonsillar fossae in children having undergone adenotonsillectomy and how this impacts on anesthetic emergence and pain control in the first 24-h.
In this double-blinded, randomized, placebo-controlled trial, 80 children were stratified into two groups: Group I (3-8 years-old) and Group II (9-14 years-old). Within these groups, participants were randomized to receive either xylocaine 10% pump spray or normal saline 0.9% post-operatively. A standardized anesthetic/analgesic regime was used intra-operatively. The same surgeon performed all surgeries using bi-polar diathermy. Outcome variables included state of anesthetic emergence; pain scores at specific intervals; need for rescue analgesia; post-operative nausea and vomiting; time to first oral intake and comfort associated with initial oral intake.
Xylocaine 10% pump spray consistently provided superior pain control at all time intervals compared to normal saline 0.9% (p = 0.011). This was most pronounced in children 3-8 years old (Group I). Xylocaine 10% pump spray and normal saline 0.9% provided similar pain relief in children 9-14 years old (Group (II) (p = 0.640). Children receiving xylocaine had a decreased incidence of emergence delirium and consistently required less rescue analgesia (p = 0.005). Children who received xylocaine did not eat sooner post-operatively, but they experienced less pain when ingesting liquids (p = 0.003) and solids (p = 0.000). Children who received xylocaine did not experience increased post-operative complications (p = 1.000) or nausea and vomiting (p = 0.153).
Xylocaine 10% spray may serve as a valuable adjunct to effective pain control post-adenotonsillectomy, especially if long acting opioids are contraindicated, as with patients with obstructive sleep apnea. The benefit of xylocaine appears to be negligible when a long acting opioid is administered. The benefits of xylocaine were most noteworthy in children aged 3-8 years old. This is the largest trial (n = 80) to date to assess the efficacy of xylocaine spray in isolation post-adenotonsillectomy. Xylocaine also offers improved comfort with oral intake and decreases emergence delirium and need for rescue analgesia without any increase in post-operative complications. Local anesthesia may decrease costs and help to solve the conundrum of a painless adenotonsillectomy especially in resource-limited settings.
腺样体扁桃体切除术后疼痛通常很严重，在前 48-72 小时需要大量的镇痛。这种疼痛不仅令患者及其父母感到痛苦，而且往往反映了手术过程的不尽如人意。尽管提出了多种手术和镇痛干预措施，但安全、简单、有效的腺样体扁桃体切除术后疼痛控制仍然难以实现。
研究腺样体扁桃体切除术后即刻应用利多卡因 10%喷雾对接受腺样体扁桃体切除术的儿童扁桃体窝的镇痛作用，以及这如何影响术后 24 小时内的麻醉苏醒和疼痛控制。
在这项双盲、随机、安慰剂对照试验中，80 名儿童分为两组：I 组（3-8 岁）和 II 组（9-14 岁）。在这些组内，参与者随机接受利多卡因 10%喷雾或生理盐水 0.9%术后治疗。术中使用标准化的麻醉/镇痛方案。同一位外科医生使用双极电凝进行所有手术。结局变量包括麻醉苏醒状态；特定时间间隔的疼痛评分；需要抢救性镇痛；术后恶心和呕吐；首次口服摄入时间和初始口服摄入时的舒适度。
利多卡因 10%喷雾在所有时间点均比生理盐水 0.9%提供了更好的疼痛控制（p=0.011）。在 3-8 岁的儿童中（I 组），这种效果最为明显。利多卡因 10%喷雾和生理盐水 0.9%在 9-14 岁的儿童中提供了相似的疼痛缓解（p=0.640）。使用利多卡因的儿童出现苏醒谵妄的发生率较低，且始终需要较少的抢救性镇痛（p=0.005）。使用利多卡因的儿童术后进食时间不会更早，但他们在摄入液体（p=0.003）和固体（p=0.000）时疼痛减轻。使用利多卡因的儿童没有出现增加的术后并发症（p=1.000）或恶心和呕吐（p=0.153）。
利多卡因 10%喷雾可能是腺样体扁桃体切除术后有效疼痛控制的有用辅助手段，特别是在存在阻塞性睡眠呼吸暂停等情况下，禁忌使用长效阿片类药物时。当使用长效阿片类药物时，利多卡因的益处可以忽略不计。利多卡因的益处在 3-8 岁的儿童中最为显著。这是迄今为止评估腺样体扁桃体切除术后单独使用利多卡因喷雾疗效的最大试验（n=80）。利多卡因还可以提高口服摄入的舒适度，减少苏醒谵妄和抢救性镇痛的需要，而不会增加术后并发症。局部麻醉可能会降低成本，并有助于解决无痛腺样体扁桃体切除术的难题，尤其是在资源有限的环境中。
