Consequences of Inadequate Analgesia During Painful Procedures in Children

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Abstract
Objective To explore the effect of inadequate analgesia for painful procedures (bone marrow aspiration, lumbar puncture, or both) on the pain of subsequent procedures. Design 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. Participants Twenty-one children undergoing diagnostic procedures who had been participants in a previous study. Intervention 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. Results 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 (P=.04). Older children (n=8) did not show this pattern. Conclusion Inadequate analgesia for initial procedures in young children may diminish the effect of adequate analgesia in subsequent procedures.