Consequences of Inadequate Analgesia During Painful Procedures in Children

TLDR

The study investigates how inadequate analgesia during initial painful procedures affects pain experienced in later procedures. A cohort of 21 pediatric oncology patients who had previously participated in a placebo‑controlled trial received open‑label oral transmucosal fentanyl (15–20 µg/kg) before subsequent procedures, and pain was self‑rated afterward. In children under 8, pain ratings were consistently higher after initial placebo compared to active drug, a statistically significant difference (P = .04); older children showed no such pattern.

Abstract

<h3>Objective</h3> To explore the effect of inadequate analgesia for painful procedures (bone marrow aspiration, lumbar puncture, or both) on the pain of subsequent procedures. <h3>Design</h3> A cohort of patients with cancer who had participated in a placebo-controlled, randomized study that documented the efficacy of oral transmucosal fentanyl citrate for painful procedures rated the pain associated with subsequent procedures performed with open-label oral transmucosal fentanyl. <h3>Participants</h3> Twenty-one children undergoing diagnostic procedures who had been participants in a previous study. <h3>Intervention</h3> All children were given oral transmucosal fentanyl, 15 to 20 µg/kg, prior to the procedure; at its conclusion they were asked to rate the associated pain. <h3>Results</h3> In children younger than 8 years (n=13), mean pain ratings during each subsequent procedure were consistently higher for those who had received placebo (n=8) in the original study compared with those who had received the active drug (n=5). A repeated-measures analysis of variance suggests that this difference is statistically significant (<i>P</i>=.04). Older children (n=8) did not show this pattern. <h3>Conclusion</h3> Inadequate analgesia for initial procedures in young children may diminish the effect of adequate analgesia in subsequent procedures.