Lu Nathan E, Shaffer Amber D, Rushchak Marina V, Maguire Raymond C, Jabbour Noel, Tobey Allison B J, McCoy Jennifer L, Chi David H
Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Int J Pediatr Otorhinolaryngol. 2025 Jun;193:112361. doi: 10.1016/j.ijporl.2025.112361. Epub 2025 Apr 21.
Our purpose was to determine if non-opioid pain control is safe and effective in the treatment of pain following intracapsular adenotonsillectomy (T&A).
A randomized, open-label, controlled trial of children ages 3-17 undergoing intracapsular T&A was conducted at a tertiary children's hospital April 2021-May 2023. Exclusions were concomitant procedures, Down syndrome, coagulopathy, craniofacial anomalies, and current opioid use. Participants were randomized to receive a prescription for oxycodone (opioid group) or not (non-opioid group). All patients received ibuprofen/acetaminophen. The primary outcome, average Wong-Baker FACES pain scores on post-operative days 0-14, was compared between groups using t-tests. The secondary outcome, emergency department (ED)/urgent care visits, was compared using logistic regression.
Age (median 4, range 3-12) and gender (42/70, 60 % male) were similar in both groups. Pain diaries were returned by 21/36 (58 %) in the opioid group and 23/34 (68 %) of the non-opioid group. Average pain was not different between groups before (opioid: mean 3.2, 95 % CI 2.5-3.8; non-opioid: mean 3.3, 95 % CI 2.5-4.0) or after (opioid: mean: 1.1, 95 % CI 0.6-1.5; non-opioid mean: 1.0, 95 % CI 0.5-1.5) analgesics. Only 7/21 (33 %) of the opioid group took ≥1 dose of oxycodone; no patients in the non-opioid group requested an opioid prescription. There were no differences in peak pain scores, duration of analgesic use, ED/urgent care visits, or caregiver-reported symptoms or satisfaction between groups.
Pain scores were low compared with previous reports in children undergoing extracapsular T&A, suggesting non-opioid management is appropriate for pain control in this population.
我们的目的是确定非阿片类药物控制疼痛在治疗囊内腺样体扁桃体切除术（T&A）后疼痛方面是否安全有效。
2021年4月至2023年5月在一家三级儿童医院对3至17岁接受囊内T&A的儿童进行了一项随机、开放标签、对照试验。排除标准包括同期进行的其他手术、唐氏综合征、凝血功能障碍、颅面畸形以及当前使用阿片类药物。参与者被随机分为接受羟考酮处方（阿片类药物组）或不接受（非阿片类药物组）。所有患者均接受布洛芬/对乙酰氨基酚治疗。使用t检验比较两组在术后0至14天的主要结局，即平均面部表情疼痛评分。使用逻辑回归比较次要结局，即急诊室（ED）/紧急护理就诊情况。
两组的年龄（中位数4岁，范围3至12岁）和性别（42/70，60%为男性）相似。阿片类药物组21/36（58%）和非阿片类药物组23/34（68%）返回了疼痛日记。两组在使用镇痛药之前（阿片类药物组：平均3.2，95%置信区间2.5至3.8；非阿片类药物组：平均3.3，95%置信区间2.5至4.0）或之后（阿片类药物组：平均1.1，95%置信区间0.6至1.5；非阿片类药物组平均1.0，95%置信区间0.5至1.5）的平均疼痛无差异。阿片类药物组中只有7/21（33%）服用了≥1剂羟考酮；非阿片类药物组中没有患者要求开具阿片类药物处方。两组在疼痛峰值评分、镇痛药使用持续时间、ED/紧急护理就诊情况或照顾者报告的症状或满意度方面均无差异。
与先前关于接受囊外T&A儿童的报告相比，疼痛评分较低，这表明非阿片类药物管理适用于该人群的疼痛控制。
