Mahrose Ramy, Shorbagy Mohammed Sayed, Kasem Amr A
Assistant Professor of Anesthesiology, Intensive Care & Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Anesth Pain Med. 2024 Jul 10;14(3):e146617. doi: 10.5812/aapm-146617. eCollection 2024 Jun.
Otolaryngology often involves adenotonsillectomies, surgical procedures aimed at addressing obstructive sleep-disordered breathing and underlying apnea in children.
Pediatric anesthesiologists and otolaryngologists encounter challenges in managing pain post-adenotonsillectomy, especially due to the use of opioid medications in children who have an elevated baseline risk of airway obstruction and associated morbidity and mortality.
This prospective, randomized, double-blinded study was conducted at Eldemerdash Hospital, Ain Shams University, Egypt, from September 2022 to August 2023. A total of 90 patients aged 5 - 13 years who underwent elective tonsillectomy surgery were randomly assigned to two groups, with 45 patients in each group. The first group, referred to as group A, received intravenous 1.0 μg/kg fentanyl, dexamethasone 150 μg/kg, and paracetamol 15 mg/kg. The second group, referred to as group B, received dexamethasone 150 μg/kg and paracetamol 15 mg/kg, with an opioid-free pterygopalatine ganglion block for multimodal anesthesia. The primary outcome measure of this study was the postoperative Wong-Baker scale at 1st, 3rd, and 24th hours.
This study included 90 individuals with similar demographic profiles and comparable initial characteristics and surgical techniques in both groups (P > 0.05). Intraoperative heart rate, mean blood pressure, additional analgesia, postoperative Wong-Baker scale, postoperative rescue analgesia, and laryngospasm did not show significant differences between the two groups (P > 0.05). However, there were statistically significant differences between the groups in terms of nausea, vomiting, hypoxia, and post-anesthesia care unit stay, with group B experiencing fewer of these issues (P < 0.05).
Both conventional opioid-based multimodal anesthesia and opioid-free pterygopalatine ganglion block-based multimodal anesthesia are effective methods for providing analgesia during and after tonsillectomy surgery. The pterygopalatine ganglion block, the latter option, has been found to result in fewer postoperative complications such as nausea, vomiting, and hypoxia. Additionally, patients who receive this type of anesthesia typically require less time in the post-anesthesia care unit.
耳鼻喉科经常涉及腺样体扁桃体切除术，这是一种旨在解决儿童阻塞性睡眠呼吸障碍及潜在呼吸暂停问题的外科手术。
儿科麻醉医生和耳鼻喉科医生在腺样体扁桃体切除术后的疼痛管理方面面临挑战，尤其是在基线气道阻塞风险升高且伴有发病率和死亡率的儿童中使用阿片类药物时。
这项前瞻性、随机、双盲研究于2022年9月至2023年8月在埃及艾因夏姆斯大学的埃尔德梅达什医院进行。共有90例年龄在5至13岁之间接受择期扁桃体切除术的患者被随机分为两组，每组45例。第一组称为A组，接受静脉注射1.0μg/kg芬太尼、150μg/kg地塞米松和15mg/kg对乙酰氨基酚。第二组称为B组，接受150μg/kg地塞米松和15mg/kg对乙酰氨基酚，并采用无阿片类药物的翼腭神经节阻滞进行多模式麻醉。本研究的主要结局指标是术后第1、3和24小时的面部表情疼痛量表评分。
本研究纳入了90名个体，两组的人口统计学特征相似，初始特征和手术技术相当（P>0.05）。两组在术中心率、平均血压、额外镇痛、术后面部表情疼痛量表评分、术后补救性镇痛和喉痉挛方面无显著差异（P>0.05）。然而，两组在恶心、呕吐、缺氧和麻醉后监护病房停留时间方面存在统计学显著差异，B组出现这些问题的较少（P<0.05）。
传统的基于阿片类药物的多模式麻醉和基于无阿片类药物的翼腭神经节阻滞的多模式麻醉都是扁桃体切除术中及术后提供镇痛的有效方法。后一种选择翼腭神经节阻滞已被发现可减少术后恶心、呕吐和缺氧等并发症。此外，接受这种麻醉的患者在麻醉后监护病房的时间通常较短。
