Objective To observe the efficacy and safety of tramadol combined with acetaminophen suppository after pedi-atric combined tonsillectomy and adenoidectomy. Methods 80 cases of children,ASA grading I to II,between 4 to 9 years oldwho were undergoing elective combined tonsillectomy and adenoidectomy were selected and randomized divided into tramadol+acet-aminophen group( group A) or tramadol group( group T) . All children received 2 mg/kg intravenous tramadol 5 min before the end of the procedure for analgesia. Children from groupA received one acetaminophen suppository(150mg)to rectum through anus after intubation inductedby anesthesia,and received another one 6h later. The Riker sedation and agitation score( SAS) was used to as-sess the agitation of the childrenin PACUin anesthesia recovery period. Wong-Baker facial expression scale was used to access the pain at 1h(T1),6h(T2),12h(T3),and 24h(T4)after operation. Results There was no statistically significant difference be-tween the two groups inextubation time and PACU residence time after operation(P>0. 05). Compared with group T,theagitation-score of group A was significantly lower at 10min after going into PACU and the time of leaving PACU(P<0. 05),and there was no significant difference between the two groups in other time(P>0. 05). The pain scores at T1 and T2 after operation of group A was significantlylowerthan those of group T of(P<0. 05),while there was no significant difference between the two groups in the scores at T3 and T4 after operation(P>0. 05). Ingroup A,the pain score at T1 after operation were significantly higher than T2,T3 and T4(P<0. 05),and there was no significant difference between T2,T3 and T4after operation(P>0. 05). In group T,the pain score at T1 and T2 were significantly higher than T3 and T4 after operation(P<0. 05),but no significant difference was found be-tween T3 and T4,and there was no significant difference between T1 and T2(P>0. 05). Conclusion Tramadol combined with acetaminophen can effectively enhance the analgesic effect within 12 hours after surgery,reduce agitation in anesthesia recovery pe-riod and does not increase extubation time,PACU residence time or incidence of adverse reactions.%目的 观察曲马多联合对乙酰氨基酚栓用于小儿扁桃体联合腺样体切除术后镇痛的有效性及安全性.方法 选取择期行扁桃体联合腺样体切除的患儿80例,年龄4~9岁,ASA分级Ⅰ~Ⅱ级.随机分为曲马多+对乙酰氨基酚镇痛组(A组)和曲马多单独镇痛组(T组).所有患儿在手术结束前5min静脉推注曲马多2mg/kg进行镇痛.A组患儿在麻醉诱导插管结束后,经肛门向直肠塞入对乙酰氨基酚栓剂1粒(150mg),并于6h后再重复给予对乙酰氨基酚栓剂1粒.对进入PACU患儿采用Riker镇静和躁动评分(SAS)行苏醒期躁动评分.采用Wong-Baker面部表情量表进行术后1h(T1)、6h(T2)、12h(T3)、24h(T4)疼痛评分.结果 两组患儿手术结束后,拔管时间和在PACU停留时间的组间比较差异无统计学意义(P>0.05).与T组比较,A组苏醒期躁动评分入PACU10min,离开PACU,明显降低,差异有统计学意义(P<0.05);其余时间段差异无统计学意义(P>0.05).A组术后T1、T2疼痛评分低于T组,差异有统计学意义(P<0.05),两组术后T3、T4评分差异无统计学意义(P>0.05);A组内比较术后疼痛T1评分高于术后T2、T3、T4,差异有统计学意义(P<0.05);而T2、T3、T4之间差异无统计学意义(P>0.05).T组内比较术后疼痛T1、T2评分高于术后T3、T4,差异有统计学意义(P<0.05);而T3、T4比较差异无意义,T1、T2比较差异无统计学意义(P>0.05)).结论 曲马多联合对乙酰氨基酚可有效增强术后12h内镇痛的效果,减少苏醒期躁动;且不增加拔管时间、PACU的停留时间及不良反应的发生率.
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