Oral morphine for pain management in paediatric patients after tonsillectomy and adenotonsillectomy
Oral morphine for pain management in paediatric patients after tonsillectomy and adenotonsillectomy
复制标题
DOI：
10.1016/j.ijporl.2015.09.040
复制
发表时间：
2015-12-01
影响因子：
1.5
通讯作者：
Hans, P.
中科院分区：
文献类型：
--
作者：
Oremule, B.;Johnson, M.;Hans, P.
目的：扁桃体切除术后停用可待因迫使我们改变了常规提供扑热息痛和布洛芬的做法，可待因用于突破性疼痛缓解。我们的目标是;检查对乙酰氨基酚和布洛芬的有效性;检查在常规的对乙酰氨基酚和布洛芬中加入急救（PRN）吗啡的有效性。对74名接受扁桃体切除术和腺样体切除术的儿童的父母进行了电话咨询。第1周期（C1，无吗啡）包含24名连续患者，第2周期（C2，有吗啡）包含50名连续患者。记录术后卫生服务联系和结局：使用经验证的疼痛评估工具获得第4天和第7天的最差疼痛评分，评分为0-10。第2周期的结果按手术方法进行亚组分析，即低温消融（C2C）和冷钢剥离（C2 D）组。超过一半的父母认为简单镇痛在两个周期中不够有效，这一数字在两个第二周期组中显著更高（Cl = 54%，C2C = 74%，p = 0.003，C2D = 84%，p = 0.0001）。所有组在第4天报告的平均最严重疼痛相似，但吗啡组在第7天报告的疼痛更高（C1 1.6，C2C 3.59，p = 0.017，C2 D 3.90，p = 0.002）。吗啡组中，术后接触GP的儿童的抗生素处方显著较低（Cl 24%，C2C 7%，p = 0.0014，C2 D 5%，p = 0.0002）。第二周期groups.Conclusion之间的测量结果没有差异：这项服务评估发现，术后吗啡按需的基础上，除了定期扑热息痛和布洛芬，并没有显着改变初始疼痛的轮廓，最严重的疼痛评分或健康服务接触率相比，定期扑热息痛和布洛芬单独。这项研究中的大多数儿童认为需要额外的镇痛。吗啡组的儿童在手术后接触GP时经历的药物干预明显较少。(C)2015爱思唯尔爱尔兰有限公司版权所有。
Objectives: The withdrawal of codeine for use in children following tonsillectomy enforced a change in our practice of providing regular paracetamol and ibuprofen, with codeine for breakthrough pain relief. Our objectives were to; examine the effectiveness of paracetamol and ibuprofen; examine the effectiveness of the addition of rescue (PRN) morphine to regular paracetamol and ibuprofen.Methods: A 2 cycle prospective audit was conducted on our unit. Telephone consultations were conducted with parents of 74 children undergoing tonsillectomy and adenotonsillectomy. Cycle 1 (Cl, without morphine) contained 24 consecutive patients and cycle 2 (C2, with morphine) contained 50 consecutive patients. Postoperative health service contact and outcome was recorded: worst pain scores on days 4 and 7 were obtained using validated pain assessment tools scoring 0-10. Cycle 2 results underwent subgroup analysis by method of surgery i.e. coblation (C2C) and cold steel dissection (C2D) groups.Results: More than half of parents felt simple analgesia was not effective enough in both cycles, this number was significantly higher in both 2nd cycle groups (Cl = 54%, C2C = 74%, p = 0.003, C2D = 84%, p = 0.0001). Mean worst pain reported at day 4 was similar for all groups, but the morphine groups reported higher pain at day 7(C1 1.6, C2C 3.59, p = 0.017, C2D 3.90, p = 0.002). Antibiotic prescribing for children contacting a GP after surgery was significantly lower in the morphine groups (Cl 24%, C2C 7%, p = 0.0014, C2D 5%, p = 0.0002). There was no difference in measured outcomes between the 2nd cycle groups.Conclusion: This service evaluation found that postoperative morphine on an as-required basis, in addition to regular paracetamol and ibuprofen, did not significantly alter initial pain profile, worst pain scores or rate of health service contact when compared to regular paracetamol and ibuprofen alone. The majority of children in this study felt additional analgesia required. Children in the morphine groups experienced significantly less pharmacological intervention when contacting the GP after surgery. (C) 2015 Elsevier Ireland Ltd. All rights reserved.