title: Intranasal fentanyl versus placebo for pain in children during catheterization for voiding cystourethrography.
abstract: BACKGROUND
  Voiding cystourethrogram (VCUG) is a common procedure at pediatric tertiary care centres that can be painful as it involves a urinary catheter. Currently there are no widely utilized protocols for non-topical medications to decrease pain that children feel during catheterization.
  
  
  OBJECTIVE
  To determine if intranasal (IN) fentanyl is effective at decreasing pain that children feel during catheterization of VCUG when compared with sterile water.
  
  
  METHODS
  We performed a double-blind randomized controlled trial, using IN fentanyl (2 microg/kg) compared to placebo (sterile water,) in children 4-8 years of age scheduled for elective VCUG in one urban pediatric tertiary center.
  
  
  RESULTS
  Using the Face Pain Score-Revised, children receiving IN fentanyl scored 2.58 (1.93-3.25 95% CI) while those receiving sterile water scored 2.86 (2.20-3.51 95% CI) showing no statistically significant difference. There were no adverse events.
  
  
  CONCLUSIONS
  Although we were unable to show a statistically significant difference between our study and control groups, we believe that this may be due to technique (positioning, delivery device) and timing of administration of IN fentanyl as well as multi-factorial causes of distress during VCUG. Future studies investigating alternative delivery techniques of IN fentanyl for analgesia during VCUG may yield more promising results.
authors.affiliation: Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
authors.forename: Seen
authors.initials: S
authors.lastname: Chung
authors.forename: Ruth
authors.initials: R
authors.lastname: Lim
authors.forename: Ran D
authors.initials: RD
authors.lastname: Goldman
mesh_terms: D000281:Administration, Intranasal; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology* / Q000517:prevention & control*; D010147:Pain Measurement / Q000187:drug effects; D015990:Placebo Effect; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000009:adverse effects*; D014554:Urination; D014567:Urography / Q000009:adverse effects*
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl