Analgetikabedarf bei Kindern im Alter zwischen 2 und 12 Jahren nach Tonsillenoperationen

Zusammenfassung

Hintergrund Mandeloperationen bei Kindern zählen zu den schmerzhaftesten Eingriffen. Altersgerechte Schmerzskalen sind die Kindliche Unbehagens- und Schmerzskala (KUSS), die Faces Pain Scale–Revised (FPS-R) und der kaum bekannte PPPM-D-Fragebogen. Ziel war Evaluation der Analgesie bei durch Eltern angeforderter Nichtopioid-Medikation (NOM) mit Ibuprofen (IBU) und Paracetamol (PCM) nach intrakapsulärer Tonsillektomie (TO) oder extrakapsulärer Tonsillektomie (TE). Als Rescue-Medikation (RM) wurde nach Prüfung der Schmerzskalen Piritramid appliziert. Endpunkte waren Anteil der Patienten (PAT), der die RM benötigte, Menge applizierter NOM, Übereinstimmung der Indikation in verschiedenen Schmerzskalen, Korrelation von Schmerzen mit Prämedikation und Eingriffsdauer.

Material/Methoden Postoperativ erfolgten 3 Messungen täglich mit KUSS bei PAT ≤ 4 Jahre bzw. FPS-R ≥ 5 Jahre. Eltern füllten den PPPM-D aus. Bei einem Wert ≥ 4 bei KUSS bzw. FPS-R oder ≥ 6 im PPPM-D wurde die RM indiziert.

Ergebnisse 68 PAT wurden in eine Zwischenauswertung eingeschlossen. Durchschnittliche tägliche NOM in den ersten 3 Tagen: nach TE 14,1–16,3 mg/Kg IBU und 4,2–12,4 mg/Kg PCM bzw. nach TO 10,8–14,7 mg/Kg IBU und 5,2–8,8 mg/Kg PCM. Bei 212 Visiten wurde die RM indiziert, davon 121 Mal nur durch den PPPM-D. Nach Ausschluss eventuell falsch-positiver Indikationen benötigten 67 % der PAT nach TE und 48 % der PAT nach TO mindestens einmal die RM. Die Studie wurde wegen des hohen RM-Bedarfs abgebrochen.

Schlussfolgerungen Der Bedarf an NOM wurde unterschätzt. Der PPPM-D kombiniert mit etablierten Skalen kann die postoperative Schmerztherapie verbessern.

Abstract

Objective Tonsil surgery is one of the most painful operations in childhood. The Children’s and Infants’ Postoperative Pain Scale (CHIPPS), the Faces Pain Scale–Revised (FPS-R) and the little-known German version of the parents’ postoperative pain measure (PPPM-D) are age-appropriate measures. Children undergoing intracapsular tonsillectomy (TO) or extracapsular tonsillectomy (TE) received the non-opioids ibuprofen (IBU) and paracetamol (PCM) on a „as needed“-basis requested by parents. A pain service checked pain scales and applied piritramide as rescue medication (RM) if required. Objective was evalution of sufficient analgesia. Endpoints were number of patients (PAT) needing the RM, doses of requested non-opioids, consistency of indications in different pain scales and correlation between pain and efficacy of the premedication or duration of the intervention.

Material/Methods 3 measures were carried out daily: CHIPPS for PAT ≤ 4 years old, FPS-R from the age of 5. Parents completed the PPPM-D. Exceeding a cut-off score of 4 in CHIPPS or FPS-R or 6 in PPPM-D was rated as indication for RM.

Results We included 68 PAT in an interim analysis. Mean daily doses of non-opioids within the first 3 postoperative days were as follows: PAT undergoing TE got 14,1–16,3 mg/Kg IBU and 4,2–12,4 mg/Kg PCM. PAT undergoing TO got 10,8–14,7 mg/Kg IBU and 5,2–8,8 mg/Kg PCM. On 212 visits PAT required RM, but 121 times it was detected in the PPPM-D only. After exclusion of potentially false-positive results remained 67 % PAT after TE and 48 % PAT after TO with at least 1 indication for RM. The study was terminated due to the high need for RM.

Conclusions The need of non-opioids was underrated. Combining the PPPM-D with established measures may improve the postoperative pain therapy.

Schlüsselwörter

Tonsillektomie - Kindliche Unbehagens- und Schmerzskala (KUSS) - Faces Pain Scale–Revised (FPS-R) - Piritramid - Parents’ Postoperative Pain Measure-Deutsch (PPPM-D)

Key words

tonsillectomy - Children’s and Infants’ Postoperative Pain Scale (CHIPPS) - Faces Pain Scale–Revised (FPS-R) - Parents’ Postoperative Pain Measure (PPPM) - piritramide

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