【罂粟摘要】扁桃体切除术前景指南：系统回顾和具体术后疼痛处理建议
扁桃体切除术前景指南：
系统回顾和具体术后疼痛处理建议
尽管扁桃体切除术是最常见的外科手术之一，其疼痛管理仍然具有挑战性。治疗方案的具体疗效和风险应指导基于证据的疼痛管理方案的选择，并应在没有伤害的前提下优化镇痛。本项系统回顾的目的是评估现有文献，并提出扁桃体切除术后最佳疼痛处理的建议。采用首选报告项目进行系统回顾，结合特异性术后疼痛管理(PROSPECT)方法进行meta分析指南。纳入截至2019年11月以英语发表的随机对照试验，从止痛剂、麻醉剂或手术干预的使用等方面评估术后疼痛。检索到719项潜在符合条件的研究中，排除了涉及检查手术技术的研究后，226项随机对照试验符合纳入标准。改善术后疼痛的术前和术中干预措施包括使用扑热息痛;非甾体抗炎药;静脉注射地塞米松;氯胺酮(仅用于儿童);加巴喷丁;右美托咪定;蜂蜜;和针灸疗法。使用局部麻醉浸润;抗生素和硫酸镁的证据存在相互矛盾。使用可乐定的有效证据有限。扁桃体切除术的镇痛方案应包括扑热息痛;非甾体抗炎药;静脉注射地塞米松和阿片类镇痛药物。镇痛辅助手段，如术中和术后针灸疗法以及术后服用蜂蜜也被推荐。当一线镇痛药存在使用禁忌时，也可以考虑氯胺酮(只适用于儿童);右美托咪定或者加巴喷丁类药物。缓解扁桃体切除术后疼痛最有效的药物、风险和药物配伍仍需要进一步的随机对照试验确定。
Tonsillectomy is one of the most frequently performed surgical procedures; however, pain management remains challenging. Procedure-specifific effificacy as well as specifific risks of treatment options should guide selection of pain management protocols based on evidence and should optimise analgesia without harm. The aims of this systematic review were to evaluate the available literature and develop recommendations for optimal pain management after tonsillectomy. A systematic review utilising preferred reporting items for systematic reviews and meta-analysis guidelines with procedure-specifific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language up to November 2019 assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identifified. Out of the 719 potentially eligible studies identifified, 226 randomised controlled trials met the inclusion criteria, excluding the studies examining surgical techniques. Pre-operative and intra-operative interventions that improved postoperative pain were paracetamol; non-steroidal anti-inflflammatory drugs; intravenous dexamethasone; ketamine (only assessed in children); gabapentinoids; dexmedetomidine; honey; and acupuncture. Inconsistent evidence was found for local anaesthetic infifiltration; antibiotics; and magnesium sulphate. Limited evidence was found for clonidine. The analgesic regimen for tonsillectomy should include paracetamol; non-steroidal anti-inflflammatory drugs; and intravenous dexamethasone, with opioids as rescue analgesics. Analgesic adjuncts such as intra-operative and postoperative acupuncture as well as postoperative honey are also recommended. Ketamine (only for children); dexmedetomidine; or gabapentinoids may be considered when some of the fifirst-line analgesics are contra-indicated. Further randomised controlled trials are required to defifine risk and combination of drugs most effective for postoperative pain relief after tonsillectomy.
翻译：曹莹
编辑：佟睿
审校：曹莹