布洛芬注射液在小儿骨科麻醉恢复室镇痛中的应用

目的评估布洛芬注射液在麻醉恢复室内治疗小儿骨科全麻术后疼痛的镇痛效果和安全性。方法将湖南省儿童医院100例骨科手术后苏醒时重度疼痛(FLACC评分≥4分)的1~15岁儿童随机分为布洛芬组(n=50)和曲马多组(n=50)。布洛芬组静脉滴注布洛芬注射液10 mg/kg,曲马多组静脉滴注曲马多注射液2 mg/kg,于10 min内完成。观察各组的镇痛效果以及治疗后即刻不良反应。结果与用药前比较,各组的FLACC评分均降低(P<0.001)。布洛芬组和曲马多组的时效曲线下面积分别为(13194±1965)和(8258±1617),差异有统计学意义(P=0.027)。在治疗后不良反应方面,布洛芬组略低于曲马多组,但差异没有统计学意义(χ²=2.098,P=0.148)。布洛芬组和曲马多组补救镇痛的比例分别为18%(9/50)和40%(20/50),差异有统计学意义(χ²=5.877,P=0.015)。整体镇痛效果评估结果显示,布洛芬组和曲马多组治疗等级判定为“显效”和“完善”的比例分别为82%(41/50)和58%(29/50),差异有统计学意义(χ²=6.857,P=0.009);最常见的不良反应为头晕(11例),两组在呕吐、镇痛、呼吸抑制、发热等方面的差异无统计学意义(P>0.05)。结论布洛芬注射液是恢复室内治疗小儿术后疼痛安全有效的药物,静脉输注布洛芬注射液10 mg/kg耐受性良好,并且能够产生优于2 mg/kg曲马多的镇痛效果。此外,注射用布洛芬具有减少阿片类药物用量的优势,是术后早期疼痛控制的一个安全选择。

Application of analgesia of intravenous ibuprofen for orthopedic children in PACU

Objective To observe the efficacy and safety of intravenous analgesia of ibuprofen versus tramadol in postanesthesia care unit(PACU)for orthopedic children under general anesthesia.Methods A total of 100 children aged 1 to 15 years with FLACC score ≥4 were randomly divided into ibuprofen(A,n=50)and tramadol(B,n=50)groups.Group A received a single dose of 10 mg/kg Ⅳ-ibuprofen while Group B a single dose of 2 mg/kg IV-tramadol.The profiles of efficacy and treatment-emergent adverse event(AE)were observed.Global evaluations were conducted for overall treatment efficacy before leaving PACU.Results The FLACC score of each group was significantly lower than that pre-dosing(P<0.001).The pain intensity difference(PAID)of Group A was greater than that of Group B and the inter-group difference was statistically significant(P=0.027).In terms of AE,Group A was slightly lower than Group B.However,the difference was not statistically significant(P=0.148).The percentage of rescue analgesia was(18%,9/50)for ibuprofen and(40%,20/50)for tramadol.And the difference was statistically significant(χ²=5.877,P=0.015).As for overall analgesic efficacy,the effective or efficacious percentage was(82%,41/50)for ibuprofen and(58%,29/50)for tramadol.And the difference was statistically significant(χ²=6.857,P=0.009).The most frequent AE was dizziness(n=11).No significant inter-group difference existed in vomiting,sedation,respiratory depression,fever or other aspects.Conclusion Intravenous ibuprofen is both safe and effective for relieving postoperative pain in children.An injection dose of 10 mg/kg is well-tolerated and produces better analgesic effect than tramadol 2 mg/kg.It is a safe option for immediate postoperative pain relief.