Comparison Effect of Intravenous Ketamine with Pethidine for Analgesia and Sedation during Bone Marrow Procedures in Oncologic Children: A Randomized, Double-Blinded, Crossover Trial
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Abstract
Background: Children suffering from cancer always require pain relief and reduce anxiety when undergoing painful procedures. The aim of this study is to compare the effect of pethedine and ketamine administration in cancer-diagnosed children undergoing bone marrow aspiration and biopsy procedures.
Subjects and Methods: A randomized, double-blinded, crossover trial was carried out on 57 children undergoing painful procedures (bone marrow aspiration/biopsy). Patients were randomly assigned in a double-blinded fashion to receive either intravenous pethedine (1 mg/kg/dose) or ketamine (1 mg/kg/dose), respectively. The effectiveness of the drug was measured utilizing three parameters; perception of procedural pain with Wong-Baker Faces Pain Rating Scale and Richmond Agitation-Sedation Scale (RASS), hemodynamic changes and respiration and the frequency of vomiting nausea score.
Results: Additionally, hemodynamic stability and pain control were significantly better in the patients receiving ketamine (p<0.05, at 0, 15, 30 min). Nausea and vomiting were more frequent in Group K than in Group M but there were no significant differences. No serious complications were observed.
Conclusion: This study showed that intravenous ketamine generated a superior clinical effect in decreased pain. Ketamine may also be recommended as a reasonable option before oncology procedures in children suffering from cancer.
Hjortholm N, Jaddini E, Hałaburda K. Strategies of pain reduction during the bone marrow biopsy. Ann Hematol. 2013; 92(2): 145–9.
Lamas A, López-Herce J. Monitoring sedation in the critically ill child. Anaesthesia. 2010; 65(5):516-24.
Kurdi MS, Theerth KA, Deva RS. Ketamine: Current applications in anesthesia, pain, and critical care. Anesth Essays Res. 2014; 8(3): 283–90.
Lord S, Bhuller K. Managing pain and anxiety in adult bone marrow examinations: combining pharmacological and psychological approaches. J Pain Symptom Manage. 2012; 44(5):757-62.
Sollazzo F, Tendas A, Conte E, et al. Bone marrow aspiration and biopsy-related pain management. Ann Hematol. 2014; 93(6):1061-2.
Von Heijne M, Bredlöv B, Söderhäll S, et al. Propofol or propofol-alfentanil anesthesia for painful procedures in the pediatric oncology ward. Paediatr Anaesth. 2004; 14(8):670-5.
Schell K, Briening E, Lebet R, et al. Comparison of Arm and Calf Automatic, Non-invasive Blood Pressures In Pediatric Intensive Care Patients. J Pediatr Nurs. 2011; 26(1): 3–12.
Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation–Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002; 166(10): 1338-44.
Ely EW, Truman B, Shintani A, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003; 289(22):2983-91.
Sessler CN, Grap MJ, Ramsay MA. Evaluating and monitoring analgesia and sedation in the intensive care unit. Crit Care. 2008; 12(Suppl 3): S2.
Turhanoğlu S, Kararmaz A, Ozyilmaz MA, et al. Effects of different doses of oral ketamine for premedication of children. Eur J Anaesthesiol. 2003; 20(1): 56-60.
Stewart KG, Rowbottom SJ, Aitken AW, et al. Oral ketamine premedication for paediatric cardiac surgery-a comparison with intramuscular morphine (both after oral trimeprazine). Anaesth Intensive Care. 1990; 18(1):11-4.
Younge PA, Kendall JM. Sedation for children requiring wound repair: a randomised controlled double blind comparison of oral midazolam and oral ketamine. Emerg Med J. 2001; 18(1):30-3.
Banerjee B, Bose A, Pahari S, et al. A comparative study of paediatric oral premedication: midazolam, ketamine and low dose combination of midazolam and ketamine. J Indian Med Assoc. 2011; 109(6):386-8.
Narendra PL, Naphade RW, Nallamilli S, et al. A comparison of intranasal ketamine and intranasal midazolam for pediatric premedication. Anesth Essays Res. 2015; 9(2): 213–18.
Khatavkar SS, Bakhshi RG. Comparison of nasal Midazolam with Ketamine versus nasal Midazolam as a premedication in children. Saudi J Anaesth. 2014; 8(1): 17–21.
Gharde P, Chauhan S, Kiran U. Evaluation of efficacy of intranasal midazolam, ketamine and their mixture as premedication and its relation with bispectral index in children with tetralogy of fallot undergoing intracardiac repair. Ann Card Anaesth. 2006; 9(1):25-30.
Alderson PJ, Lerman J. Oral premedication for paediatric ambulatory anaesthesia: a comparison of midazolam and ketamine. Can J Anaesth. 1994; 41(3):221-6.
Darlong V, Shende D, Singh M, et al. Low-versus high-dose combination of midazolam-ketamine for oral premedication in children for ophthalmologic surgeries. Singapore Med J. 2011; 52(7): 512-6.
Nagel K, Willan AR, Lappan J, et al. Pediatric oncology sedation trial (POST): A double-blind randomized study. Pediatr Blood Cancer. 2008; 51(5):634-8.
Ljungman G, Gordh T, Sörensen S, et al. Lumbar puncture in pediatric oncology: conscious sedation vs. general anesthesia. Med Pediatr Oncol. 2001; 36(3):372-9.
Krauss BS, Krauss BA, Green SM. Procedural Sedation and Analgesia in Children. N Engl J Med. 2014; 370:e23.
Silva PS L, Iglesias SB O, FV L, et al. Procedural sedation for insertion of central venous catheters in children: comparison of midazolam/fentanyl with midazolam/ketamine. Paediatr Anaesth. 2007; 17(4):358-63.
Araujo CC, Lima MC, Falbo GH. Percutaneous subclavian central venous catheterization in children and adolescents: success, complications and related factors. J Pediatr (Rio J). 2007; 83(1):64-70.
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| Issue | Vol 10, No 4 (2016) | |
| Section | Articles | |
| Keywords | ||
| Cancer Pain Pediatric Analgesia | ||
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