Archives of otolaryngology--head & neck surgery · 2001
Ropivacaine with or without clonidine improves pediatric tonsillectomy pain.
Клиническое исследованиеСравнительное исследованиеСтатьяРандомизированное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Giannoni C, White S, Enneking F K, Morey T
Аннотация
OBJECTIVE: To determine if preemptive analgesia with ropivacaine hydrochloride with or without clonidine hydrochloride decreases pain and hastens recovery after tonsillectomy.
DESIGN: Prospective, randomized, triple-blinded trial.
SETTING: University referral center; pediatric ambulatory practice.
PARTICIPANTS: Sixty-four children, aged 3 to 15 years, undergoing tonsillectomy.
INTERVENTIONS: Patients received injections in the tonsillar fossae of isotonic sodium chloride, ropivacaine, or ropivacaine plus clonidine prior to tonsil excision.
MAIN OUTCOME MEASURES: Visual analogue (pain) scale scores at rest and when drinking, opioid use, recovery time to normal activity, and incidence of symptoms such as otalgia.
RESULTS: Pain was reduced on postoperative day 0 in the ropivacaine-treated and ropivacaine plus clonidine-treated groups as compared with the isotonic sodium chloride-treated group (P<.05). Pain was also decreased in the ropivacaine plus clonidine-treated group on postoperative days 3 and 5 (P<.05). Intravenous narcotic use was decreased on day 0 in the ropivacaine-treated and ropivacaine plus clonidine-treated groups (P<.05). Cumulative codeine use was similar at day 3 for all patients, but was decreased at day 5 in the ropivacaine plus clonidine-treated group (P<.05). The incidence of otalgia decreased from 89% (16/18) in the isotonic sodium chloride-treated group to 63% (12/19) in the ropivacaine-treated and 61%(11/18) in the ropivacaine plus clonidine-treated groups (P<.01). Recovery to normal activity was shortened from 8.1 +/- 1.6 days to 5.8 +/- 2.9 days (mean +/- SD) in the isotonic sodium chloride-treated and ropivacaine plus clonidine-treated groups, respectively (P =.03).
CONCLUSION: Preincisional injection of ropivacaine with clonidine prior to tonsillectomy has a preemptive analgesic effect that outlasts the local anesthetic and decreases pain, opioid use, and the time to return to normal activity.
DESIGN: Prospective, randomized, triple-blinded trial.
SETTING: University referral center; pediatric ambulatory practice.
PARTICIPANTS: Sixty-four children, aged 3 to 15 years, undergoing tonsillectomy.
INTERVENTIONS: Patients received injections in the tonsillar fossae of isotonic sodium chloride, ropivacaine, or ropivacaine plus clonidine prior to tonsil excision.
MAIN OUTCOME MEASURES: Visual analogue (pain) scale scores at rest and when drinking, opioid use, recovery time to normal activity, and incidence of symptoms such as otalgia.
RESULTS: Pain was reduced on postoperative day 0 in the ropivacaine-treated and ropivacaine plus clonidine-treated groups as compared with the isotonic sodium chloride-treated group (P<.05). Pain was also decreased in the ropivacaine plus clonidine-treated group on postoperative days 3 and 5 (P<.05). Intravenous narcotic use was decreased on day 0 in the ropivacaine-treated and ropivacaine plus clonidine-treated groups (P<.05). Cumulative codeine use was similar at day 3 for all patients, but was decreased at day 5 in the ropivacaine plus clonidine-treated group (P<.05). The incidence of otalgia decreased from 89% (16/18) in the isotonic sodium chloride-treated group to 63% (12/19) in the ropivacaine-treated and 61%(11/18) in the ropivacaine plus clonidine-treated groups (P<.01). Recovery to normal activity was shortened from 8.1 +/- 1.6 days to 5.8 +/- 2.9 days (mean +/- SD) in the isotonic sodium chloride-treated and ropivacaine plus clonidine-treated groups, respectively (P =.03).
CONCLUSION: Preincisional injection of ropivacaine with clonidine prior to tonsillectomy has a preemptive analgesic effect that outlasts the local anesthetic and decreases pain, opioid use, and the time to return to normal activity.