The effect of fentanyl and clonidine on early postoperative negative behavior in children: a double-blind placebo controlled trial
The effect of fentanyl and clonidine on early postoperative negative behavior in children: a double-blind placebo controlled trial
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DOI：
10.1111/pan.12388
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发表时间：
2014-06-01
影响因子：
1.7
通讯作者：
Ingelmo, Pablo M.
中科院分区：
文献类型：
--
作者：
Bortone, Luciano;Bertolizio, Gianluca;Ingelmo, Pablo M.
研究背景术后早期负性行为（e-PONB）在儿童中较为常见，表现为苏醒期躁动（EA）、苏醒期谵妄（艾德）和疼痛。这个前瞻性的双盲，随机，安慰剂对照试验的目的是确定是否IV可乐定或IV芬太尼手术前修改e-PONB在children.MethodsNinety儿童计划subbumbersurgery下七氟烷麻醉补充区域麻醉随机接受IV可乐定2 mcg kg（-1），IV芬太尼2 mcg kg（-1）或安慰剂（IV盐水）手术前。主要结果指标为觉醒后第一小时内EA、艾德和疼痛的发生率。次要结果的措施是副作用，如恶心，呕吐和延迟出院PACU.ResultsEighty-seven儿童（n=29每组）完成了研究。10名儿童出现EA（6名可乐定，无芬太尼，4名安慰剂，P=0.04），而20名儿童观察到艾德（9名可乐定，3名芬太尼，8名安慰剂，P=0.13）。16名接受安慰剂的儿童CHIPPS评分为4分，而芬太尼组为9名，可乐定组为18名（P=0.04）。芬太尼组术后第1天呕吐10例，安慰剂组6例，可乐定组0例（P=0.003）。从PACU放电不受影响。ConclusionsIV芬太尼手术前，但不是IV可乐定修改e-PONB在儿童接受下腹部手术全麻补充区域麻醉。在这一人群中使用芬太尼也与觉醒后疼痛评分降低相关，但PONV的发生率显著增加。
BackgroundEarly negative postoperative behavior (e-PONB) is common in children and manifests itself as emergence agitation (EA), emergence delirium (ED), and pain. The objective of this prospective double blind, randomized, placebo-controlled trial was to determine whether IV clonidine or IV fentanyl prior to surgery modifies e-PONB in children.MethodsNinety children scheduled for subumbilical surgery under sevoflurane anesthesia supplemented with regional anesthesia were randomized to either receive IV clonidine 2mcgkg(-1), IV fentanyl 2mcgkg(-1) or placebo (IV saline) before surgery. Primary outcome measures were the incidence of EA, ED and pain during the first hour after awakening. Secondary outcome measures were side effects such as nausea and vomiting and delayed discharge from PACU.ResultsEighty-seven children (n=29 per group) completed the study. EA was present in 10 children (six clonidine, none fentanyl, and four placebo, P=0.04) whereas ED was observed in 20 children (nine clonidine, three fentanyl, and eight placebo P=0.13). Sixteen children who received placebo had a CHIPPS score of 4 compared with nine children in fentanyl group and 18 children receiving clonidine (P=0.04). Ten children receiving fentanyl vomited during the first postoperative day, compared with six children in placebo group and none in clonidine group (P=0.003). Discharge from PACU was not affected.ConclusionsIV fentanyl before surgery but not IV clonidine modifies e-PONB in children undergoing lower abdominal surgery under general anesthesia supplemented with regional anesthesia. The use of fentanyl in this population was also associated with reduced pain scores after awakening but with significantly greater incidence of PONV.