title: Prospective randomized crossover evaluation of three anesthetic regimens for painful procedures in children with cancer.
abstract: OBJECTIVE
  To identify the most effective sedation regimen for bone marrow aspiration and lumbar puncture procedures with a prospective trial of 3 combinations of sedation/analgesia.
  
  
  METHODS
  In this double-blind crossover study, we randomly assigned 162 children with acute lymphoblastic leukemia or lymphoblastic lymphoma to receive fentanyl 1 mcg/kg, fentanyl 0.5 mcg/kg, or placebo, in addition to propofol and topical anesthetic for 355 procedures.
  
  
  RESULTS
  We found no significant differences among the 3 regimens in the frequency of pain (pain score > 0) or severe pain (pain score ≥ 5) during recovery, or a >20% increase in hemodynamic/respiratory variables during anesthesia. Treatment with fentanyl 1 mcg/kg was associated with a lower frequency of movement during procedure compared with treatment with fentanyl 0.5 mcg/kg (P = .0476) or treatment with placebo (P = .0545). The placebo group required longer time to recover (median, 18 minutes) compared with the fentanyl 0.5 mcg/kg group (median, 9 minutes) (median difference 2.0, P = .007) and the fentanyl 1 mcg/kg (median 8 minutes), (median difference 2.0, P = .15). The placebo group also required larger total dose of propofol (median 5 mg/kg) compared with that of the fentanyl 1 mcg/kg group (median, 3.5 mg/kg) and the fentanyl 0.5 mcg/kg group (median 3.5 mg/kg) (median differences 1.5, P < .00005, in both comparisons).
  
  
  CONCLUSIONS
  The addition of fentanyl 1 mcg/kg to propofol for brief painful procedures reduces movement, propofol dose, and recovery time.
authors.affiliation: Division of Anesthesia and Pain Management Service, St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA. doralina.anghelescu@stjude.org
authors.forename: Doralina L
authors.initials: DL
authors.lastname: Anghelescu
authors.forename: Laura L
authors.initials: LL
authors.lastname: Burgoyne
authors.forename: Lane G
authors.initials: LG
authors.lastname: Faughnan
authors.forename: Gisele M
authors.initials: GM
authors.lastname: Hankins
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Smeltzer
authors.forename: Ching-Hon
authors.initials: CH
authors.lastname: Pui
mesh_terms: D000293:Adolescent; D000758:Anesthesia; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001856:Bone Marrow Examination / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D054810:Deep Sedation; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D009369:Neoplasms; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D013129:Spinal Puncture / Q000009:adverse effects
chemical_list: D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D005283:Fentanyl; D015742:Propofol