Patient-controlled analgesia with fentanil and midazolam in children with postoperative neurosurgical pain.
BACKGROUND
Pain is the most common discomfort experienced by children undergoing major operations. It is most often not adequately treated because of inexperience and unfounded fears related to the use of opioid drugs. In adults, patient-controlled analgesia (PCA) is widely administered, while in children, its use with opioid drugs is still under evaluation for safety and efficacy.


OBJECTIVE
The objective of the study is to evaluate the safety and efficacy of an opioid drug (fentanil) administered by PCA associated with a sedative-adjuvant drug (midazolam) administered by continuous infusion in children having undergone major neurosurgical procedures.


METHODS
Sixteen children with moderate to severe postoperative pain were treated with fentanil by PCA (booster doses of 1 microg/kg) plus continuous infusion of midazolam (2 microg/kg per min) by an intravenous route. To evaluate safety and efficacy of this analgesic protocol, different subjective and objective parameters were monitored at 4-h intervals. In addition, patients' satisfaction was assessed by a questionnaire at the end of the treatment.


RESULTS
All children experienced a good degree of analgesia and did not require any other analgesic drug during the treatment. Both subjective and objective parameters improved after starting pain-relieving treatment, and no major side effects occurred. The analysis of the answers of the questionnaire administered to the children showed a high grade of satisfaction.


CONCLUSIONS
PCA with fentanil plus continuous infusion of midazolam is a safe and efficacious method for analgesia in children with moderate to severe postoperative neurosurgical pain. The association of midazolam to fentanil also contributes to control anxiety and stress in this subset of patients and does not show any important side effects.
Chiaretti
Antonio
A
Pediatric Intensive Care Unit, A. Gemelli Hospital, Catholic University of Rome, Largo A. Gemelli, 8, 00168, Rome, Italy. achiaretti@yahoo.it
Genovese
Orazio
O
Antonelli
Alessia
A
Tortorolo
Luca
L
Ruggiero
Antonio
A
Focarelli
Benedetta
B
Di Rocco
Concezio
C
D000293:Adolescent; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002648:Child; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007276:Injections, Intraventricular; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009422:Nervous System Diseases / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D010549:Personal Satisfaction; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D018686:Anesthetics, Intravenous; D008874:Midazolam; D005283:Fentanyl