Cui Xiaohuan, Zhang Jianmin, Gao Zhengzheng, Sun Lan, Zhang Fuzhou
Department of Anesthesiology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China.
Front Pediatr. 2022 Aug 16;10:956660. doi: 10.3389/fped.2022.956660. eCollection 2022.
Tonsillectomy is a recognized treatment for children with tonsil hypertrophy and results in significant postoperative oropharyngeal pain. Fentanyl and other morphine-like analgesics are widely used as perioperative analgesia but are associated with side effects such as vomiting, nausea, and respiratory depression. As the least toxic non-steroidal anti-inflammatory drug, ibuprofen may be effective and safe for pain control after tonsillectomy. We aimed to explore whether the addition of intravenous (IV) ibuprofen administered at induction can reduce the need for early postoperativeanalgesics.
This randomized, double-blind, controlled clinical trial enrolled 95 pediatric patients who underwent tonsillectomy. Participants aged 6 months to 12 years were randomly assigned to either the experimental and control groups (1:1). The children were premedicated 15 min before surgery with IV ibuprofen 10 mg kg or placebo (normal saline). Pain was scored at 15, 30, and 120 min after extubation, and IV fentanyl (0.5 mcg kg) was administered when the Faces, Legs, Activity, Cry, and Consolability (FLACC) Scale was ≥7 and deemed appropriate by the nursing staff in the post-anesthesia care unit (PACU). The visual analog scale was used as a supplementary evaluation for older children (≥7 years old) who were awake and could self-report pain. The primary outcome variable was the number of patients who received postoperative analgesia.
The requirement for rescue fentanyl was reduced by 18% with the addition of IV ibuprofen ( = 0.043). There were no signficant differences in the amount of fentanyl administered postoperatively ( = 0.127). Compared with the placebo group, the number of children who needed more than one dose of rescue fentanyl decreased in the experimental group, but the differences were not significant ( = 0.056). There were no significant differences between the groups in terms of operative blood loss ( = 0.978), vomiting, or postoperative bleeding ( = 0.474).
It is safe to administer IV ibuprofen 15 min before tonsillectomy, and it can significantly reduce the need for rescue fentanyl. IV ibuprofen should be considered as an important part of the multimodal approach for postoperative analgesia in children.
Chictr.org.cn, identifier: ChiCTR2100044508.
扁桃体切除术是治疗扁桃体肥大儿童的一种公认方法，但术后会导致明显的口咽疼痛。芬太尼和其他吗啡类镇痛药被广泛用作围手术期镇痛，但会产生如呕吐、恶心和呼吸抑制等副作用。作为毒性最小的非甾体抗炎药，布洛芬可能对扁桃体切除术后的疼痛控制有效且安全。我们旨在探讨诱导时静脉注射布洛芬是否能减少术后早期镇痛药物的使用需求。
这项随机、双盲、对照临床试验纳入了95例行扁桃体切除术的儿科患者。年龄在6个月至12岁的参与者被随机分配到试验组和对照组（1:1）。患儿在手术前15分钟静脉注射10毫克/千克布洛芬或安慰剂（生理盐水）进行术前用药。拔管后15分钟、30分钟和120分钟进行疼痛评分，当面部、腿部、活动、哭闹和安慰度（FLACC）量表评分≥7分且麻醉后护理单元（PACU）的护理人员认为合适时，静脉注射芬太尼（0.5微克/千克）。视觉模拟量表用于对清醒且能自我报告疼痛的大龄儿童（≥7岁）进行补充评估。主要结局变量是接受术后镇痛的患者数量。
静脉注射布洛芬使抢救用芬太尼的需求减少了18%（P = 0.043）。术后芬太尼的使用量无显著差异（P = 0.127）。与安慰剂组相比，试验组中需要一剂以上抢救用芬太尼的儿童数量有所减少，但差异不显著（P = 0.056）。两组在手术失血量（P = 0.978）、呕吐或术后出血方面无显著差异（P = 0.474）。
扁桃体切除术前15分钟静脉注射布洛芬是安全的，且能显著减少抢救用芬太尼的需求。静脉注射布洛芬应被视为儿童术后镇痛多模式方法的重要组成部分。
Chictr.org.cn，标识符：ChiCTR2100044508。
