title: Consequences of inadequate analgesia during painful procedures in children.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  Twenty-one children undergoing diagnostic procedures who had been participants in previous study.
  
  
  METHODS
  All children were given oral transmucosal fentanyl, 15 to 20 microgram/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.
  
  
  CONCLUSIONS
  Inadequate analgesia for initial procedures in young children may diminish the effect of adequate analgesia in subsequent procedures.
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, New Haven, Conn, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Weisman
authors.forename: B
authors.initials: B
authors.lastname: Bernstein
authors.forename: N L
authors.initials: NL
authors.lastname: Schechter
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000704:Analysis of Variance; D001007:Anxiety / Q000209:etiology* / Q000517:prevention & control*; D001856:Bone Marrow Examination / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D009061:Mouth Mucosa; D010146:Pain / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology*; D010147:Pain Measurement; D013129:Spinal Puncture / Q000009:adverse effects
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl