Prospective Randomized Crossover Evaluation of Three Anesthetic Regimens for Painful Procedures in Children with Cancer - 20/12/12
, Laura L. Burgoyne, BM, BS 1, 
, Lane G. Faughnan, RN, BSN, CCRP 1, Gisele M. Hankins, RN, BSN, CCRP 2, Matthew P. Smeltzer, MStat 3, Ching-Hon Pui, MD 4Reprint requests: Doralina L. Anghelescu, MD, Division of Anesthesia, Mail Stop 130, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-2794.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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| Supported by the Cancer Center Support grant (5P30CA021765-32) and the American Lebanese Syrian Associated Charities, neither of which had any involvement in the planning or conduct of this study. The authors declare no conflicts of interest. |
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| Registered with ClinicalTrials.gov: NCT00187135. |
Vol 162 - N° 1
P. 137-141 - gennaio 2013 Ritorno al numero
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