Pre- Versus Post-Tonsillectomy Intraoperative Bupivacaine Injection in the Pediatric Population: An Age- and Surgical Indication-Stratified Analysis.

Autor:	Ji KSY; Department of Otolaryngology-Head & Neck Surgery, Oregon Health & Science University, Portland, OR, USA., Greene NH; Division of Pediatrics, Department of Anesthesiology, Duke University Hospital, Durham, NC, USA., Eapen RJ; South Bay Pediatric Otolaryngology, Manhattan Beach, CA, USA., Commesso E; Department of Head and Neck Surgery & Communication Sciences, Duke University Hospital, Durham, NC, USA., Raynor EM; Department of Head and Neck Surgery & Communication Sciences, Duke University Hospital, Durham, NC, USA.
Jazyk:	angličtina
Zdroj:	Ear, nose, & throat journal [Ear Nose Throat J] 2022 Sep; Vol. 101 (8), pp. 518-525. Date of Electronic Publication: 2020 Oct 23.
DOI:	10.1177/0145561320968926
Abstrakt:	Objectives: Postoperative respiratory depression is of concern in children undergoing adenotonsillectomy receiving postoperative opioids and may be mitigated with intraoperative bupivacaine. This study aims to compare the impact of bupivacaine on postoperative pain and sedation in various pediatric age and surgical indication subgroups. Methods: This is a case series with chart review of 181 patients <18 years old undergoing adenotonsillectomy at a tertiary care center (2013-2016). Postoperative outcomes were compared between those who received intraoperative bupivacaine before (pre-tonsillectomy) or after (post-tonsillectomy) tonsil removal and those who did not (none) using χ 2 test and analysis of variance. Subanalysis was performed after stratifying into age and surgical indication subgroups. Results: Ninety-eight patients were included in the pre-tonsillectomy group, 47 in the post-tonsillectomy group, and 36 in the none group. The number of postanesthesia care unit opioid doses ( P = .159) and pain scores at arrival ( P = .362) or discharge ( P = .255) were not significantly different between treatment groups overall. Among 0- to 5-year-olds, pre-tonsillectomy injection was associated with lowest mean (SD) discharge pain score of 0.55 (1.29) pre-tonsillectomy versus 0.71 (1.37) post-tonsillectomy versus 2 (1.63) none group ( P = .004). Among 12- to 17-year-olds, no injection was associated with lowest mean (SD) discharge pain score of 2.33 (0.52) pre-tonsillectomy versus 5 (2.65) post-tonsillectomy versus 1.63 (1.60) none group ( P = .020). Injection in patients with obstructive sleep apnea and/or sleep-disordered breathing did not improve postoperative outcomes. Conclusion: Intraoperative bupivacaine may improve pain scores in younger pediatric populations, though it may not impact the amount of postoperative opioid use. Prospective analysis with a larger sample size is warranted to better outline opioid usage and pain control in this group.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu