对乙酰氨基酚和布洛芬固定剂量复方制剂治疗儿童急性轻中度疼痛：通过德尔菲共识加强和提高名义群体技术的结果。
Paracetamol and ibuprofen fixed-dose combination for the management of acute mild-to-moderate pain in children: strengthening and enhancing of result of Nominal Group Technique through Delphi consensus.
机构信息
Department of Pediatric Emergency, Regina Margherita Children's Hospital, Turin, Italy.
Department of Emergency Medicine and Trauma Center, Meyer Children's Hospital IRCCS, Florence, Italy.
出版信息
Ital J Pediatr. 2024 Oct 29;50(1):223. doi: 10.1186/s13052-024-01791-x.
BACKGROUND
Paracetamol and ibuprofen are the most commonly used drugs for pain treatment in children and their combination has shown improved analgesic effect compared to treatment with either drug alone. Current literature lacks specific guidelines regarding the settings in which this combination should be adopted.
METHODS
The survey, conducted with Delphi methodology, involved 75 hospital and outpatient pediatricians with clinical experience in the management of pain in children. Pediatricians involved were asked to validate or not the results of the previous NominalGroup Tecnique (NGT) consensus and thus specify the optimal clinical settings in which the paracetamol/ibuprofen fixed-dose combination could be adopted.
RESULTS
The results confirm the importance of the fixed-dose paracetamol and ibuprofen combination for the control of mild-to-moderate acute pain in children. Particularly, this association seems to be appropriate in case of headache, earache, odontalgia and musculoskeletal pain, and in specific settings such as post-operative and post-procedural pain. The broadening of the panel brought to slight variations in clinical management practices between hospital and outpatient specialists. Nonetheless, overall consensus supports the notion that the fixed dose combination is more efficacious than monotherapies and it is well tolerated. Moreover, experts unanimously agree on the usefulness of the combination for caregivers, leading to improved adherence and effectiveness.
CONCLUSIONS
Both the NGT consensus and the broader Delphi consensus confirm the usefulness of the paracetamol-ibuprofen fixed-dose combination in pediatric pain. This is attributed to its superior effectiveness compared to monotherapies, a good tolerability profile, and improved compliance and ease of use. Some pain settings related to chronic, inflammatory and rheumatological pathologies remain to be investigated to evaluate the use of this combination.
背景
对乙酰氨基酚和布洛芬是儿童最常用的止痛药物，两者联合使用的止痛效果优于单一用药。目前的文献缺乏关于应在何种情况下采用这种联合用药的具体指南。
方法
本研究采用德尔菲法，对 75 名具有儿童疼痛管理临床经验的医院和门诊儿科医生进行了调查。请参与调查的儿科医生对之前的名义群体技术（NGT）共识结果进行验证或不验证，并指定对乙酰氨基酚/布洛芬固定剂量联合用药的最佳临床应用场景。
结果
结果证实了固定剂量对乙酰氨基酚和布洛芬联合治疗儿童轻中度急性疼痛的重要性。特别是，这种联合用药在治疗头痛、耳痛、牙痛和肌肉骨骼疼痛以及术后和术后疼痛等特定情况下似乎是合适的。扩大专家小组后，医院和门诊专家在临床管理实践方面略有差异。尽管如此，总体共识支持固定剂量联合用药比单一用药更有效且耐受性良好的观点。此外，专家们一致认为该固定剂量联合用药对护理人员有用，可提高其依从性和效果。
结论
NGT 共识和更广泛的德尔菲共识均证实了对乙酰氨基酚-布洛芬固定剂量联合用药在儿科疼痛中的有效性。这归因于其与单一用药相比具有更好的疗效、良好的耐受性以及更高的依从性和易用性。一些与慢性、炎症和风湿性疾病相关的疼痛情况仍有待研究，以评估这种联合用药的使用。
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