Adler Adam C, Vernick Robert C, Tanwani Anika, Kim Hye Min, Nguyen Duc T, Aras Sukru, Messner Anna H
Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, Texas, USA.
Baylor College of Medicine, Houston, Texas, USA.
Acta Anaesthesiol Scand. 2025 Sep;69(8):e70106. doi: 10.1111/aas.70106.
Pre-emptive analgesia may be of benefit in reducing total opioid use and improving the pain experience perioperatively. However, there is conflicting evidence as to the benefits of pre-emptive analgesia, with limited evidence in children. The aim of this study was to examine the association between preoperative use of hydrocodone with acetaminophen and total opioid consumption in children undergoing adenotonsillectomy.
This was a retrospective cohort study of the children undergoing adenotonsillectomy surgery at Texas Children's Hospital between 11/2017 and 12/2018. Preoperative use of hydrocodone with acetaminophen was the exposure of interest. The primary outcome was total perioperative opioid consumption calculated as oral morphine equivalents (OME). Secondary outcomes of interest included: post-anesthesia care unit (PACU) pain experience and time to discharge. We used multivariable linear regression to estimate the association of hydrocodone with acetaminophen on the outcomes.
A total of 1082 patients met inclusion criteria, 366 (33.8%) received pre-operative hydrocodone with acetaminophen. There was no difference in the total intraoperative and postoperative OME between groups, mean OME of 0.49 mg/kg (±0.23) in the HA group versus 0.50 mg/kg (±0.27) in the control group; p = 0.56. For PACU discharge, the median [IQR] for PACU discharge time was longer in the patients who did not receive preoperative HA, at 39.0 [25.0-58.0] versus 30.0 [20.0-46.0] min for the preoperative HA group. Use of preoperative HA was associated with a 61% likelihood of having a PACU discharge time exceeding 30 min, with an odds ratio (OR) of 0.39 (95% CI, 0.28, 0.54; p < 0.001). Use of preoperative HA resulted in a greater likelihood of exhibiting a maximal pain score of 0-3 in PACU, with an OR of 2.16 (95% CI, 1.56-2.99; p < 0.001), as well as an increased likelihood of a having a maximum recorded pain score of zero, with an OR of 1.85 (95% CI, 1.34-2.56; p < 0.001).
Pre-operative hydrocodone with acetaminophen was associated with improved outcomes with respect to PACU pain experience and time to discharge. The total OME increase was limited to the pre-operative HA dose.
超前镇痛可能有助于减少阿片类药物的总用量，并改善围手术期的疼痛体验。然而，关于超前镇痛的益处存在相互矛盾的证据，且在儿童中的证据有限。本研究的目的是探讨术前使用氢可酮与对乙酰氨基酚联合用药与接受腺样体扁桃体切除术儿童的阿片类药物总消耗量之间的关联。
这是一项对2017年11月至2018年12月在德克萨斯儿童医院接受腺样体扁桃体切除术的儿童进行的回顾性队列研究。术前使用氢可酮与对乙酰氨基酚联合用药是感兴趣的暴露因素。主要结局是围手术期阿片类药物总消耗量，以口服吗啡当量（OME）计算。感兴趣的次要结局包括：麻醉后护理单元（PACU）的疼痛体验和出院时间。我们使用多变量线性回归来估计氢可酮与对乙酰氨基酚联合用药与结局之间的关联。
共有1082例患者符合纳入标准，366例（33.8%）接受了术前氢可酮与对乙酰氨基酚联合用药。两组术中及术后的OME总量无差异，氢可酮与对乙酰氨基酚联合用药组的平均OME为0.49mg/kg（±0.23），对照组为0.50mg/kg（±0.27）；P = 0.56。对于PACU出院情况，未接受术前氢可酮与对乙酰氨基酚联合用药的患者PACU出院时间的中位数[四分位间距]更长，分别为39.0[25.0 - 58.0]分钟和术前氢可酮与对乙酰氨基酚联合用药组的30.0[20.0 - 46.0]分钟。术前使用氢可酮与对乙酰氨基酚联合用药与PACU出院时间超过30分钟的可能性增加61%相关，优势比（OR）为0.39（95%CI，0.28，0.54；P < 0.001）。术前使用氢可酮与对乙酰氨基酚联合用药导致在PACU中最大疼痛评分为0 - 3的可能性更大，OR为2.16（95%CI，1.56 - 2.99；P < 0.001），以及最大记录疼痛评分为零的可能性增加，OR为1.85（95%CI，1.34 - 2.56；P < 0.001）。
术前使用氢可酮与对乙酰氨基酚联合用药与PACU疼痛体验和出院时间方面的结局改善相关。OME总量的增加仅限于术前氢可酮与对乙酰氨基酚联合用药的剂量。
