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Randomized Controlled Trial
. 2013 Jan;162(1):137-41.
doi: 10.1016/j.jpeds.2012.06.056. Epub 2012 Aug 9.

Prospective randomized crossover evaluation of three anesthetic regimens for painful procedures in children with cancer

Doralina L Anghelescu  1 , Laura L Burgoyne, Lane G Faughnan, Gisele M Hankins, Matthew P Smeltzer, Ching-Hon Pui
Affiliations
Randomized Controlled Trial

Prospective randomized crossover evaluation of three anesthetic regimens for painful procedures in children with cancer

Doralina L Anghelescu et al. J Pediatr. 2013 Jan.

Abstract

Objective: To identify the most effective sedation regimen for bone marrow aspiration and lumbar puncture procedures with a prospective trial of 3 combinations of sedation/analgesia.

Study design: In this double-blind crossover study, we randomly assigned 162 children with acute lymphoblastic leukemia or lymphoblastic lymphoma to receive fentanyl 1 mcg/kg, fentanyl 0.5 mcg/kg, or placebo, in addition to propofol and topical anesthetic for 355 procedures.

Results: We found no significant differences among the 3 regimens in the frequency of pain (pain score > 0) or severe pain (pain score ≥ 5) during recovery, or a >20% increase in hemodynamic/respiratory variables during anesthesia. Treatment with fentanyl 1 mcg/kg was associated with a lower frequency of movement during procedure compared with treatment with fentanyl 0.5 mcg/kg (P = .0476) or treatment with placebo (P = .0545). The placebo group required longer time to recover (median, 18 minutes) compared with the fentanyl 0.5 mcg/kg group (median, 9 minutes) (median difference 2.0, P = .007) and the fentanyl 1 mcg/kg (median 8 minutes), (median difference 2.0, P = .15). The placebo group also required larger total dose of propofol (median 5 mg/kg) compared with that of the fentanyl 1 mcg/kg group (median, 3.5 mg/kg) and the fentanyl 0.5 mcg/kg group (median 3.5 mg/kg) (median differences 1.5, P < .00005, in both comparisons).

Conclusion: The addition of fentanyl 1 mcg/kg to propofol for brief painful procedures reduces movement, propofol dose, and recovery time.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure
Figure
Flow Chart of Patient Enrollment and Randomization to Three Treatment Arms. PS: Pain score (n = number of procedures with evaluable pain scores during recovery). Note: Not all 162 randomized patients completed all 3 regimens
See this image and copyright information in PMC

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