在接受脊柱后路融合手术的儿科患者中,比较预先静脉注射对乙酰氨基酚和预防性静脉注射对乙酰氨基酚对阿片类药物消耗量的影响:随机对照试验。

IF 4.2 4区 医学 Q1 ANESTHESIOLOGY
Korean Journal of Anesthesiology Pub Date : 2024-06-01 Epub Date: 2024-02-20 DOI:10.4097/kja.23747
Yeon Ju Kim, Ha-Jung Kim, Sehee Kim, Hyungtae Kim, Choon Sung Lee, Chang Ju Hwang, Jae Hwan Cho, Young-Jin Ro, Won Uk Koh
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引用次数: 0

摘要

背景:脊柱后路融合术(PSF)常用于治疗青少年特发性脊柱侧凸(AIS),会引起严重的术后疼痛。静脉注射对乙酰氨基酚有望实现阿片类药物替代镇痛,但其镇痛效果和标准使用的最佳时机仍不明确。我们的研究旨在评估接受 PSF 且需要充分止痛的儿童和青少年患者静脉注射对乙酰氨基酚的镇痛效果和最佳用药时机:这项前瞻性、随机、三盲试验在 11-20 岁接受 PSF 的患者中进行。参与者被随机分为三组:抢先组(麻醉诱导后/手术切口前静脉注射对乙酰氨基酚 15 毫克/千克)、预防组(手术结束后/皮肤闭合前静脉注射对乙酰氨基酚 15 毫克/千克)和安慰剂组。主要结果是术后 24 小时内阿片类药物的累计用量:结果:在 99 名入选患者中,抢先治疗组、预防治疗组和安慰剂组术后 24 小时内阿片类药物消耗量的平均值(± 标准差,SD)分别为 60.66 ± 23.84 毫克、52.23 ± 22.43 毫克和 66.70 ± 23.01 毫克(总 P = 0.043)。事后分析显示,预防组的阿片类药物用量明显低于安慰剂组(p = 0.013)。然而,在次要结果方面,各组间未观察到明显差异:预防性静脉注射对乙酰氨基酚可减少接受 PSF 的儿童和青少年患者的阿片类药物累积用量,同时不会增加药物引起的不良事件的发生率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of preemptive and preventive intravenous acetaminophen on opioid consumption in pediatrics undergoing posterior spinal fusion surgery: a randomized controlled trial.

Background: Posterior spinal fusion (PSF), commonly used for adolescent idiopathic scoliosis (AIS), causes severe postoperative pain. Intravenous (IV) administration of acetaminophen has shown promise for opioid-sparing analgesia; however, its analgesic effect and optimal timing for its standard use remain unclear. Our study aimed to evaluate the analgesic effect and optimal timing of IV acetaminophen administration in pediatric and adolescent patients undergoing PSF and requiring adequate pain control.

Methods: This prospective, randomized, triple-blind trial was conducted in patients aged 11-20 undergoing PSF. Participants were randomized into three groups: the preemptive group (received IV acetaminophen 15 mg/kg after anesthetic induction/before surgical incision), the preventive group (received IV acetaminophen 15 mg/kg at the end of surgery/before skin closure), and the placebo group. The primary outcome was cumulative opioid consumption during the first 24 h postoperatively.

Results: Among the 99 enrolled patients, the mean ± standard deviation (SD) amount of opioid consumption during the postoperative 24 h was 60.66 ± 23.84, 52.23 ± 22.43, and 66.70 ± 23.01 mg in the preemptive, preventive, and placebo groups, respectively (overall P = 0.043). A post hoc analysis revealed that the preventive group had significantly lower opioid consumption than the placebo group (P = 0.013). However, no significant differences between the groups were observed for the secondary outcomes.

Conclusions: The preventive administration of scheduled IV acetaminophen reduces cumulative opioid consumption without increasing the incidence of drug-induced adverse events in pediatric and adolescent patients undergoing PSF.

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来源期刊
CiteScore
6.20
自引率
6.90%
发文量
84
审稿时长
16 weeks
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