Wong A K, Bissonnette B, Braude B M, Macdonald R M, St-Louis P J, Fear D W
Department of Anaesthesia, Hospital for Sick Children, University of Toronto, Ontario, Canada.
Can J Anaesth. 1995 Sep;42(9):770-4. doi: 10.1007/BF03011174.
Pain management after tonsillectomy in children remains a dilemma for the anaesthetist. A previous study demonstrated that the administration of lidocaine 1% topical spray to the peritonsillar fossae before tracheal extubation provided considerable immediate postoperative pain relief in infants and children. However, the pain relief was of short duration. We were hopeful that the use of bupivacaine would offer more prolonged pain relief because of its pharmacological characteristics. Therefore, this study was designed to compare the effects of bupivacaine 0.5% with 1:200,000 epinephrine administered after tonsillectomy either as topical spray or submucosal infiltration on postoperative pain in children. Forty-three patients aged two to ten years were randomized into three groups after tonsillectomy was performed. Group (1) received 0.5 ml.kg-1 normal saline spray; (2) received 2 mg.kg-1 bupivacaine 0.5% with 1:200,000 epinephrine peritonsillar infiltration in a similar volume to Group 1 and; (3) received 2 mg.kg-1 bupivacaine 0.5% with 1:200,000 epinephrine spray to both tonsillar beds. The patients in each group were compared postoperatively with regard to the quality of pain control using the Objective Pain Score, and their analgesic requirements. Peritonsillar infiltration of bupivacaine provided superior immediate postoperative analgesia as reflected by lower recovery room pain scores (P < 0.05) and opioid requirements (P < 0.01). Ward pain scores and analgesic requirements were similar among groups. Peritonsillar infiltration of bupivacaine 0.5% with 1:200,000 epinephrine provides better post-tonsillectomy pain control in the immediate postoperative period than bupivacaine spray or placebo.
儿童扁桃体切除术后的疼痛管理仍然是麻醉医生面临的一个难题。先前的一项研究表明，在气管拔管前向扁桃体周围隐窝喷洒1%利多卡因局部喷雾剂，可为婴幼儿和儿童提供显著的术后即时疼痛缓解。然而，疼痛缓解持续时间较短。鉴于布比卡因的药理特性，我们希望使用布比卡因能提供更持久的疼痛缓解。因此，本研究旨在比较扁桃体切除术后给予0.5%布比卡因与1:200,000肾上腺素作为局部喷雾剂或黏膜下浸润对儿童术后疼痛的影响。43名年龄在2至10岁的患者在接受扁桃体切除术后被随机分为三组。第（1）组接受0.5 ml·kg-1生理盐水喷雾；第（2）组接受2 mg·kg-1 0.5%布比卡因与1:200,000肾上腺素，扁桃体周围浸润，体积与第1组相似；第（3）组接受2 mg·kg-1 0.5%布比卡因与1:200,000肾上腺素喷洒双侧扁桃体床。术后比较每组患者使用客观疼痛评分的疼痛控制质量及其镇痛需求。布比卡因扁桃体周围浸润提供了更好的术后即时镇痛效果，表现为恢复室疼痛评分更低（P < 0.05）和阿片类药物需求量更低（P < 0.01）。各组间病房疼痛评分和镇痛需求相似。0.5%布比卡因与1:200,000肾上腺素扁桃体周围浸润在扁桃体切除术后即时比布比卡因喷雾或安慰剂能更好地控制疼痛。
