Monsereenusorn Chalinee, Rujkijyanont Piya, Traivaree Chanchai
J Med Assoc Thai. 2015 Apr;98(4):358-64.
Children often require relief of pain and anxiety when undergoing painful procedures.
To determine the differences by comparing fentanyl and ketamine used in cancer-diagnosed children undergoing painful procedures.
A randomized, double-blinded, crossover trial was conducted with 55 children undergoing painful procedures (intrathecal chemotherapy and/or bone marrow aspiration/biopsy). Patients were randomly assigned in a double-blinded fashion to receive either intravenous fentanyl or ketamine at 1 mcg/kg/dose and 1 mg/kg/dose, respectively. The result in effectiveness of the drug was measured using three parameters, 1) satisfaction score ranging from 0 to 10, 2) perception of procedural pain using FLACC scale, Wong-Baker FACES Pain Rating Scale and Visual Analog Scale, and 3) the frequency of vomiting nausea score.
The satisfaction amongpatients receiving fentanyl was significantly greater than ketamine (p = 0.007). In addition, both painful and nausea/vomiting were significantly decreased in the patients receiving fentanyl (p = 0.002 and p < 0.001, respectively). No serious complications were observed
This study demonstrated that intravenous fentanyl generated a superior clinical effect in satisfaction, decreased pain and nausea/vomiting, and showed no significant side-effects over ketamine. Fentanyl may also be recommended as a reasonable option before undergoing oncology procedures in children with cancer.
儿童在接受疼痛性操作时常常需要缓解疼痛和焦虑。
通过比较芬太尼和氯胺酮在接受疼痛性操作的癌症确诊儿童中的应用，确定两者的差异。
对55名接受疼痛性操作（鞘内化疗和/或骨髓穿刺/活检）的儿童进行了一项随机、双盲、交叉试验。患者以双盲方式随机分配，分别接受静脉注射芬太尼或氯胺酮，剂量分别为1 mcg/kg/剂量和1 mg/kg/剂量。使用三个参数来衡量药物的有效性，1）满意度评分范围为0至10，2）使用FLACC量表、面部表情疼痛评分量表和视觉模拟量表评估操作疼痛感知，3）呕吐恶心评分频率。
接受芬太尼的患者满意度显著高于氯胺酮（p = 0.007）。此外，接受芬太尼的患者疼痛和恶心/呕吐均显著减轻（分别为p = 0.002和p < 0.001）。未观察到严重并发症。
本研究表明，静脉注射芬太尼在满意度、减轻疼痛和恶心/呕吐方面产生了优于氯胺酮的临床效果，且未显示出明显的副作用。芬太尼也可被推荐为癌症儿童进行肿瘤学操作前的合理选择。
