单一或联合静脉注射布洛芬或丙帕他莫减少腹腔镜疝修补术患儿术后阿片类药物使用的比较:一项双盲随机对照试验

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单一或联合静脉注射布洛芬或丙帕他莫(对乙酰氨基酚)减少腹腔镜疝修补术患儿术后阿片类药物使用的比较:一项双盲随机对照试验

贵州医科大学  麻醉与心脏电生理课题组

翻译：马艳燕  编辑：张中伟  审校：曹莹

背景   为了减少儿童术后阿片类药物的使用，医学家已经作出了大量的努力。在这项研究中，我们评估了单用丙帕他莫或一种非甾体抗炎药(NSAID)或它们的联合使用是否能有效减少腹腔镜腹股沟疝修补术后儿童阿片类药物的使用。 

方法   这项随机双盲临床试验纳入了159名6个月至6岁的儿童。将儿童分为3组：I组用10 mg·kg  −1  布洛芬治疗，P组用30 mg·kg  −1  丙帕他莫治疗，I组+P组用两种药物的各自浓度治疗。如果在麻醉后监护期间，表情-下肢-活动-哭闹-可安慰性(FLACC)评分≥4，则使用1.0 ug·kg  −1  芬太尼作为补救性镇痛药。将在麻醉后监护期间接受芬太尼补救的患者人数作为主要结局指标；使用χ2检验对此进行分析。次要结局指标包括FLACC和术后父母疼痛评估(PPPM)评分，直到术后24小时。 

结果   144名入组患者中，在麻醉后监护期间接受芬太尼补救的比率：I为组28.6%、P组为66.7%和I+P组为12.8%(P值<0.001)。I组+P组的最高FLACC评分低于I组或P组(P值分别为0.007和0.001)。术后4小时和12小时，I组+ P组的PPPM评分明显低于P组(P值分别为0.03和0.01)。

结论   与单独使用丙帕他莫相比，在儿童腹腔镜疝修补术后立即联合使用布洛芬和丙帕他莫可减少其术后阿片类药物的使用。 

原始文献来源   Hye-Mi Lee, Ji-Hoon Park, Su-Jung Park  ,  et al.     Comparison of Monotherapy Versus Combination of Intravenous Ibuprofen and Propacetamol (Acetaminophen) for Reduction of Postoperative Opioid Administration in Children Undergoing Laparoscopic Hernia Repair: A Double-Blind Randomized Controlled Trial[J].     (Anesth Analg 2021;133:168–75)  .

Comparison of Monotherapy Versus Combination of Intravenous Ibuprofen and Propacetamol (Acetaminophen) for Reduction of Postoperative Opioid Administration in Children Undergoing Laparoscopic Hernia Repair: A Double-Blind Randomized Controlled Trial

Abstract

Background: Extensive efforts have been made toward reducing postoperative opioid use in children. In this study, we assessed whether propacetamol, or a nonsteroidal antiinflammatory drug (NSAID), or their combination could effectively reduce opioid use in children after laparoscopic inguinal hernia repair

Methods: This randomized, double-blind clinical trial included 159 children aged 6 months to 6 years. Children were allocated into 1 of the following 3 groups: group I was treated with 10 mg·kg−1 ibuprofen, group P was treated with 30 mg·kg−1 propacetamol, and group I + P was treated with both drugs in their respective concentrations. If the face–legs–activity–crying–consolability (FLACC) score was ≥4 during the postanesthesia care unit stay, 1.0 µg·kg−1 fentanyl was administered as a rescue analgesic. The number of patients who received rescue fentanyl in the postanesthesia care unit was defined as the primary outcome; this was analyzed using the χ2 test. The secondary outcomes included the FLACC and the parents’ postoperative pain measure (PPPM) scores until the 24-hour postoperative period.

Results: Among the 144 enrolled patients, 28.6% in group I, 66.7% in group P , and 12.8% in group I + P received rescue fentanyl in the postanesthesia care unit (P<0.001). The highest FLACC score was lower in group I + P than in either group I or P (P=0.007 and P<0.001, respectively). Group I + P presented significantly lower PPPM scores than group P at 4 and 12 hours postoperative (P=0.03 and 0.01, respectively).

Conclusions: The use of ibuprofen plus propacetamol immediately following laparoscopic hernia repair surgery in children resulted in the reduced use of an opioid drug compared with the use of propacetamol alone.

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