Yao Phil Y, Shaw Susanna J, Gabriel Rodney A, Soria Claire S
Department of Anesthesiology University of California San Diego San Diego California USA.
Paediatr Neonatal Pain. 2022 Dec 5;5(1):10-15. doi: 10.1002/pne2.12091. eCollection 2023 Mar.
Pediatric burns affect approximately 15-20 patients per 100 000 hospital admissions, but unfortunately there is a lack of evidence to guide optimal strategies for acute pain control. The aim of this study was to evaluate whether caudal analgesia with single injection of local anesthetics reduced pain medication consumption in pediatric patients who required surgical intervention for burn injuries. Retrospective data from patients <7 years old who had burn surgery in the operating rooms at a single regional burn center from 2013 to 2021 was obtained and analyzed. A 1:1 propensity-score matching method using nearest neighbor matching without replacement was utilized to create matched cohorts. Primary outcome was opioid consumption, which is presented as opioid equivalents divided by patient weight in kilograms, at 24 h after surgery. Comparing propensity-score matched groups, there were no statistically significant differences in adjusted morphine equivalents received by the caudal group (0.122 [0.0646;0.186]) and the no caudal group (0.0783 [0.0384;0.153]) at 24 h after surgery ( = 0.06). This is the first study to the best of our knowledge of the association of caudal analgesia in pediatric burn patients with postoperative pain control. The data showed an increase in pain medication consumption postoperative at 24 h and intraoperative for patients who received single injection caudal blocks, but when adjusted using propensity-score matching, the difference was no longer statistically significant.
每10万例住院病例中约有15 - 20例小儿烧伤患者，但遗憾的是，缺乏证据来指导急性疼痛控制的最佳策略。本研究的目的是评估单次注射局部麻醉药的骶管镇痛是否能减少因烧伤需要手术干预的小儿患者的止痛药消耗量。获取并分析了2013年至2021年在一个地区烧伤中心手术室接受烧伤手术的7岁以下患者的回顾性数据。采用1:1倾向评分匹配法，使用无放回的最近邻匹配来创建匹配队列。主要结局是术后24小时的阿片类药物消耗量，以阿片类药物等效剂量除以患者体重（千克）表示。比较倾向评分匹配组，骶管组（0.122 [0.0646;0.186]）和非骶管组（0.0783 [0.0384;0.153]）在术后24小时接受的调整后吗啡等效剂量无统计学显著差异（P = 0.06）。据我们所知，这是第一项关于小儿烧伤患者骶管镇痛与术后疼痛控制相关性的研究。数据显示，接受单次注射骶管阻滞的患者术后24小时和术中止痛药消耗量增加，但使用倾向评分匹配进行调整后，差异不再具有统计学意义。
