The effect of preemptive analgesia on emergence delirium in tonsillectomy and adenotonsillectomy operations

Öz

Aim: Emergency delirium (ED) is a phenomenon of unknown etiology, mostly seen in young children, characterised by aggressive behaviour, lack of eye contact and lack of awareness of the environment. It has been shown to have many causes, but head and neck surgery, inhaled agents and post-operative pain are the most common. The most sensitive scale available is the Paediatric Anaesthesia Emergency Delirium (PAED) scale. Preemptive analgesia is the interruption of pain pathways before the painful stimulus occurs, and its effectiveness in post-operative analgesia has been confirmed by many studies. This study was designed with the hypothesis that post- operative pain reduced by preemptive analgesia would reduce ED. Material and Methods: After ethics committee approval, 96 patients aged 2-7 years undergoing adenotonsillectomy and tonsillectomy were randomised into two groups. Analgesics were administered to the preemptive group before induction and to the intra-operative group 15 min after the start of operation. In the recovery room, ED was assessed using the PAED scale and pain scores were assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scales. FLACC>7 was pain and PAED>10 was considered emergence delirium. Results: PAED and FLACC scores were significantly lower in the preemptive group. There was a significant difference in the incidence of ED between the two groups only at 5 minutes (p<0.01). Heart rate was significantly lower in the preemptive group intraoperatively (p<0.01). Conclusions: In children undergoing adenotonsillectomy and tonsillectomy, preemptive analgesia reduced postoperative pain scores and delirium scores, but did not reduce the incidence of recovery delirium.

Anahtar Kelimeler

• Emergence delirium
• postoperative pain
• preemptive analgesia
• tonsillectomy.

Teşekkür

Dr.Öğr.Üyesi İskender Aksoy'a istatistik konusunda yardımlarından dolayı teşekkür ediyoruz.

Adenotonsillektomi ve Tonsillektomi operasyonlarında preemptif analjezinin derlenme deliryumu üzerine etkisi

Öz

Amaç: Derlenme deliryumu etiyolojisi tam olarak bilinmeyen, çoğunlukla küçük çocuklarda görülen, agresif davranışlar, göz teması eksikliği ve çevrenin farkında olmamakla karakterize bir fenomendir. Birçok sebepten kaynaklanabileceği gösterilmiş ancak en çok baş-boyun cerrahisi, inhaler ajanlar ve postoperatif ağrı suçlanmaktadır. Değerlendirmek için bazı skalalar kullanılır. Duyarlılığı en yüksek olan Pediyatrik Anestezi Deliryum Skalası olan "PAED" (Pediatric Anesthesia Delirium Scale)'dir. Preemptif analjezi, ağrı yolaklarının henüz ağrılı uyaran oluşmadan kesilerek engellenmesidir ve postoperatif analjezi için etkinliği birçok çalışma ile doğrulanmıştır. Bu çalışma: preemptif analjezi yöntemi ile azaltılan postoperatif ağrının derlenme deliryumunu azaltacağı hipotez edilerek planlanmıştır. Gereç ve Yöntemler: Etik kurul onayı alındıktan sonra adenotonsillektomi ve tonsillektomi operasyonu geçirecek, 2-7 yaş arası 96 hasta iki gruba randomize edildi. Analjezikler preemptif gruba indüksiyondan önce, intraoperatif gruba ise operasyonun başlamasından 15 dakika sonra uygulandı. Derlenme ünitesinde derlenme deliryumu PAED skalası ile, ağrı skorları çocuğun yüz ifadesi, bacakların pozisyonu, hareketleri, ağlaması ve avutulabilmesi değerlendirilerek yapılan “FLACC” (Face, Legs, Activity, Cry, Consolability) ağrı değerlendirme skalası ile değerlendirildi. FLACC>7 ağrı ve PAED> 10 derlenme deliryumu kabul edildi. Bulgular: Preemptif grupta PAED ve FLACC skorları istatistiksel olarak anlamlı düşük bulundu ancak derlenme deliryum gelişme insidansı açısından iki grup arasında sadece 5.dakikada anlamlı fark saptandı (p<0.01). Premptif grubun intraoperatif tüm ölçüm zamanlarında nabız değerleri anlamlı düşük saptandı (p<0.01). Sonuç: Adenotonsilektomi ve tonsillektomi operasyonu geçiren çocuklarda uygulanan preemptif analjezi, postoperatif ağrı skorlarını ve deliryum skorlarını azaltmış ancak derlenme deliryum gelişme insidansını azaltmamıştır.

Anahtar Kelimeler

• parasetamol
• tonsillektomi
• ortaya çıkma deliryum
• analjezi

Kaynakça

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