Mendel H G, Guarnieri K M, Sundt L M, Torjman M C
Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Anesth Analg. 1995 Jun;80(6):1129-33. doi: 10.1097/00000539-199506000-00010.
Fifty-four ASA I and II children 1 to 10 yr of age undergoing strabismus surgery were randomized to receive in a double-blind fashion intravenous ketorolac (0.9 mg/kg), fentanyl (1 microgram/kg), or saline placebo (2 mL) during a standardized general anesthetic. Patients received no analgesic or antiemetics intraoperatively except for the study drug. Patients receiving ketorolac or placebo compared to fentanyl had a significantly lower incidence of postoperative vomiting in the day surgery unit (DSU) (P = 0.03) and overall (DSU plus home) (P = 0.005). The severity (number of episodes) of post-operative vomiting was significantly lower in the DSU, at home (first 24 h after hospital discharge), and overall for patients receiving ketorolac or placebo compared to fentanyl (P < 0.01). Postoperative pain scores and frequency of acetaminophen administration did not differ among the study groups, suggesting that the intraoperative use of ketorolac or fentanyl during pediatric strabismus surgery is unnecessary. No patients required fentanyl postoperatively, indicating that rectal acetaminophen administered in the postanesthesia recovery room provides sufficient analgesia for pediatric strabismus surgery. In conclusion, neither ketorolac nor fentanyl was associated with less postoperative vomiting or analgesic requirements compared to saline placebo administered during pediatric strabismus surgery. Fentanyl should be avoided, as it was associated with a significantly greater incidence of postoperative vomiting compared to ketorolac or placebo.
54名年龄在1至10岁、接受斜视手术的美国麻醉医师协会（ASA）分级为I级和II级的儿童，在标准化全身麻醉期间以双盲方式随机接受静脉注射酮咯酸（0.9毫克/千克）、芬太尼（1微克/千克）或生理盐水安慰剂（2毫升）。术中除研究药物外，患者未接受任何镇痛或止吐药物。与芬太尼组相比，接受酮咯酸或安慰剂的患者在日间手术单元（DSU）的术后呕吐发生率显著降低（P = 0.03），总体（DSU加家中）发生率也显著降低（P = 0.005）。与芬太尼组相比，接受酮咯酸或安慰剂的患者在DSU、家中（出院后最初24小时）以及总体的术后呕吐严重程度（发作次数）显著降低（P < 0.01）。研究组之间术后疼痛评分和对乙酰氨基酚的给药频率没有差异，这表明小儿斜视手术中术中使用酮咯酸或芬太尼是不必要的。没有患者术后需要芬太尼，这表明在麻醉后恢复室给予直肠对乙酰氨基酚可为小儿斜视手术提供足够的镇痛。总之，与小儿斜视手术期间给予的生理盐水安慰剂相比，酮咯酸和芬太尼均未减少术后呕吐或镇痛需求。应避免使用芬太尼，因为与酮咯酸或安慰剂相比，它与术后呕吐的发生率显著更高有关。
