Comparison Effect of Intravenous Ketamine with Sufentanil for Pain Relief during Painful Procedures in Children with Leukemia
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Abstract
Background: Children with leukemia would go through different diagnostic and therapeutic procedures during their process of their disease, including lumbar punctureand bone marrow aspiration; these procedures are usually associated with pain andstress. The aim of the present study was to compare the effect of two combinations ofPropofol-Ketamine and Propofol-Sufentanil on sedation and analgesia during painfulprocedures in children with acute lymphoblastic leukemia.
Methods: In a randomized, double-blind clinical trial, 70 children with acutelymphoblastic leukemia undergoing painful procedures were randomly allocated intotwo parallel groups and took Intravenous Ketamine (1 mg/kg/dose) or Sufentanil (0.5mcg/kg/dose). Both groups received Intravenous propofol (1.2mg/kg). Hemodynamicvariables and analgesic effect were compared between groups.
Results: There was no significant difference between the two groups in terms of thechanges in vital signs at the time before, during and after the procedure. But, theincidence of patient’s movements and the need for repeated propofol boluses wassignificantly lower in the Ketamine group compared to the Sufentanil group (P: 0.008).
Conclusion: Ketamine is a good choice for conducting painful procedures on childrenwith acute lymphoblastic leukemia. Ketamine might be a good option for pain reliefduring painful procedures such as intrathecal injection, bone marrow aspiraion.Ketamine could also be more effective in controlling the movements and decreasing theneed for repeating the drug dosage compared to the Sufentanil.
1.Yazdi AG, Ayatollahi V, Hashemi A, Behdad S, Yazdi EG. Effect of two different concentrations of propofol and ketamine combinations (Ketofol) in pediatric patients under lumbar puncture or bone marrow aspiration. Iran J Ped Hematol Oncol 2013;3(1):187-92.
2. Anghelescu DL, Burgoyne LL, Faughnan LG, Hankins GM, Smeltzer MP, Pui C-H. Prospective randomized crossover evaluation of three anesthetic regimens for painful procedures in children with cancer. J Pediatr 2013;162(1):137-41.
3. Parslow R, Morgan AJ, Allen NB, Jorm AF, O'Donnell CP, Purcell R. Effectiveness of complementary and self-help treatments for anxiety in children and adolescents. Med J Aust 2008;188(6):355-9.
4. Zeltzer LK, Tsao JC, Stelling C, Powers M, Levy S, Waterhouse M. A phase i study on the feasibility and acceptability of an acupuncture/hypnosis intervention for chronic pediatric pain. J Pain Symptom Manage 2002;24(4):437-46.
5. Dufresne A, Dugas M-A, Samson Y, Barré P, Turcot L, Marc I. Do children undergoing cancer procedures under pharmacological sedation still report pain and anxiety? A preliminary study. Pain Med 2010;11(2):215-23.
6.Miller KD, Siegel RL, Lin CC, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 2016;66(4):271-89.
7.Jaafarpour M, Vasigh A, Khajavikhan J, Khani A. Effect of ketofol on pain and complication after Caesarean delivery under spinal anaesthesia: A randomized double-blind clinical trial. J Clin Diagn Res 2017;11(3):UC04.
8.Coté CJ, Wilson S, Pediatrics AAo, Dentistry AAoP. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016. Pediatrics 2016;138(1). pii: e20161212.
9.Wang HY, Ting CK, Liou JY, Chen KH, Tsou MY, Chang WK. A previously published propofol–remifentanil response surface model does not predict patient response well in video-assisted thoracic surgery. Medicine (Baltimore) 2017;96(19):e6895.
10. Hassan NE, Betz BW, Cole MR, et al. Randomized controlled trial for intermittent versus continuous propofol sedation for pediatric brain and spine magnetic resonance imaging studies. Pediatr Crit Care Med 2011;12(6):e262-e5.
11. Hashemi A S, Ayatolahi V, Ghilian R, Ghadami Yazdi A, Fadavi N, Yadegar Y, et al . Ketofol for bone marrow aspiration and lumbar puncture in Children with ALL. Iran J Ped Hematol Oncol 2011;1(4):126-132
12. Aouad M, Moussa A, Dagher C, et al. Addition of ketamine to propofol for initiation of procedural anesthesia in children reduces propofol consumption and preserves hemodynamic stability. Acta Anaesthesiol Scand 2008;52(4):561-5.
13. Andolfatto G, Willman E. A prospective case series of pediatric procedural sedation and analgesia in the emergency department using single‐syringe Ketamine–Propofol combination (Ketofol). Acad Emerg Med 2010;17(2):194-201.
14. da Silva PS, de Aguiar VE, Waisberg DR, Passos RM, Park MV. Use of ketofol for procedural sedation and analgesia in children with hematological diseases. Pediatr Int 2011;53:62-7.
15. Evered LM. Procedural sedation and analgesia for paediatric patients in the emergency department. Paediatr Child Health 2003; 8:503–7.
16. Willman EV, Andolfatto G. A prospective evaluation of “ketofol” (ketamine/propofol combination) for procedural sedation and analgesia in the emergency department. Ann Emerg Med.2007;49:23-30.
17. Brown TB, Lovato LM, Parker D. Procedural sedation in the acute care setting. Am Fam Physician 2005; 71:85–90.
18. Dyer RA, Joubert IA. Low-dose spinal anaesthesia for caesarean section. Curr Opin Anaesthesiol 2004;17(4):301-8.
19. Veena A, Amit A, Jagdish SP, et al. Comparison of intrathecal sufentanil and morphine in addition to bupivacaine for caesarean section under spinal anesthesia. Anaesth Pain Intensive Care 2010;14 :99-101.
20. Bang YS, Chung KH, Lee JH, et al. Comparison of clinical effects according to the dosage of sufentanil added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean section. Korean J Anesthesiol 2012; 63:321-6.
21. Malviya S, Voepel-Lewis T, Tait AR, Merkel S, Tremper K, Naughton N. Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan Sedation Scale (UMSS). Br J Anaesth 2002;88(2):241-5.
22. Gregory J, Richardson C. The Use of Pain Assessment Tools in Clinical Practice: A Pilot Survey. J Pain Relief 2014;3(2):140-146.
23. Ghasemi A, Fard MG, Sabzevari A. General anesthesia for lumbar puncture and bone marrow aspiration/biopsy in children with cancer. Iran J Ped Hematol Oncol 2013;3(2):54-8.
24. Hollman GA, Schultz MM, Eickhoff JC, Christenson DK. Propofol-fentanyl versus propofol alone for lumbar puncture sedation in children with acute acute lymphoblastic leukemia: propofol dosing and adverse events. Pediatr Crit Care Med 2008;9(6): 616–622.
25. Hooke MC, Grund E, Quammen H, Miller B, McCormick P, Bostrom B. Propofol use in pediatric patients with severe cancer pain at the end of life. J Pediatr Oncol Nurs 2007;24(1):29-34.
26. David H, Shipp J. A randomized controlled trial of ketamine/propofol versus propofol alone for emergency department procedural sedation. Ann Emerg Med 2011;57(5):435-41.
27. Bajwa SJS, Bajwa SK, Kaur J. Comparison of two drug combinations in total intravenous anesthesia: Propofol–ketamine and propofol–fentanyl. Saudi J Anaesth 2010;4(2):72-9.
28. Shetabi H, Golparvar M, Ghanbardezfoli S, Torfenejad M. Sedative and analgesic efficacy of propofol-ketamine and propofol remifentanil during painful procedures in children with acute lymphoblastic leukemia. Iran J Ped Hematol Oncol 2018;8(2):87-96
29. Shetabi H, Shafa A, Zare M. Effect of Ketamine-Sufentanil and Ketamine-Midazolam to induce sedation and analgesia in pediatric with Lumbar Puncture or Bone Marrow Aspiration. AACC 2018;4(3):497-500.
30. Shetabi H, Asadi N, Golparvar M, Shafa A. The Comparison of the Effect of Ketamine-Sufentanil Combination and Propofol-Remifentanil Combination on the Quality of Sedation during Painful Procedures in Children with Hematological Malignancies. J Isfahan Med Sci 2018; 36(480):548-56.
2. Anghelescu DL, Burgoyne LL, Faughnan LG, Hankins GM, Smeltzer MP, Pui C-H. Prospective randomized crossover evaluation of three anesthetic regimens for painful procedures in children with cancer. J Pediatr 2013;162(1):137-41.
3. Parslow R, Morgan AJ, Allen NB, Jorm AF, O'Donnell CP, Purcell R. Effectiveness of complementary and self-help treatments for anxiety in children and adolescents. Med J Aust 2008;188(6):355-9.
4. Zeltzer LK, Tsao JC, Stelling C, Powers M, Levy S, Waterhouse M. A phase i study on the feasibility and acceptability of an acupuncture/hypnosis intervention for chronic pediatric pain. J Pain Symptom Manage 2002;24(4):437-46.
5. Dufresne A, Dugas M-A, Samson Y, Barré P, Turcot L, Marc I. Do children undergoing cancer procedures under pharmacological sedation still report pain and anxiety? A preliminary study. Pain Med 2010;11(2):215-23.
6.Miller KD, Siegel RL, Lin CC, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 2016;66(4):271-89.
7.Jaafarpour M, Vasigh A, Khajavikhan J, Khani A. Effect of ketofol on pain and complication after Caesarean delivery under spinal anaesthesia: A randomized double-blind clinical trial. J Clin Diagn Res 2017;11(3):UC04.
8.Coté CJ, Wilson S, Pediatrics AAo, Dentistry AAoP. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016. Pediatrics 2016;138(1). pii: e20161212.
9.Wang HY, Ting CK, Liou JY, Chen KH, Tsou MY, Chang WK. A previously published propofol–remifentanil response surface model does not predict patient response well in video-assisted thoracic surgery. Medicine (Baltimore) 2017;96(19):e6895.
10. Hassan NE, Betz BW, Cole MR, et al. Randomized controlled trial for intermittent versus continuous propofol sedation for pediatric brain and spine magnetic resonance imaging studies. Pediatr Crit Care Med 2011;12(6):e262-e5.
11. Hashemi A S, Ayatolahi V, Ghilian R, Ghadami Yazdi A, Fadavi N, Yadegar Y, et al . Ketofol for bone marrow aspiration and lumbar puncture in Children with ALL. Iran J Ped Hematol Oncol 2011;1(4):126-132
12. Aouad M, Moussa A, Dagher C, et al. Addition of ketamine to propofol for initiation of procedural anesthesia in children reduces propofol consumption and preserves hemodynamic stability. Acta Anaesthesiol Scand 2008;52(4):561-5.
13. Andolfatto G, Willman E. A prospective case series of pediatric procedural sedation and analgesia in the emergency department using single‐syringe Ketamine–Propofol combination (Ketofol). Acad Emerg Med 2010;17(2):194-201.
14. da Silva PS, de Aguiar VE, Waisberg DR, Passos RM, Park MV. Use of ketofol for procedural sedation and analgesia in children with hematological diseases. Pediatr Int 2011;53:62-7.
15. Evered LM. Procedural sedation and analgesia for paediatric patients in the emergency department. Paediatr Child Health 2003; 8:503–7.
16. Willman EV, Andolfatto G. A prospective evaluation of “ketofol” (ketamine/propofol combination) for procedural sedation and analgesia in the emergency department. Ann Emerg Med.2007;49:23-30.
17. Brown TB, Lovato LM, Parker D. Procedural sedation in the acute care setting. Am Fam Physician 2005; 71:85–90.
18. Dyer RA, Joubert IA. Low-dose spinal anaesthesia for caesarean section. Curr Opin Anaesthesiol 2004;17(4):301-8.
19. Veena A, Amit A, Jagdish SP, et al. Comparison of intrathecal sufentanil and morphine in addition to bupivacaine for caesarean section under spinal anesthesia. Anaesth Pain Intensive Care 2010;14 :99-101.
20. Bang YS, Chung KH, Lee JH, et al. Comparison of clinical effects according to the dosage of sufentanil added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean section. Korean J Anesthesiol 2012; 63:321-6.
21. Malviya S, Voepel-Lewis T, Tait AR, Merkel S, Tremper K, Naughton N. Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan Sedation Scale (UMSS). Br J Anaesth 2002;88(2):241-5.
22. Gregory J, Richardson C. The Use of Pain Assessment Tools in Clinical Practice: A Pilot Survey. J Pain Relief 2014;3(2):140-146.
23. Ghasemi A, Fard MG, Sabzevari A. General anesthesia for lumbar puncture and bone marrow aspiration/biopsy in children with cancer. Iran J Ped Hematol Oncol 2013;3(2):54-8.
24. Hollman GA, Schultz MM, Eickhoff JC, Christenson DK. Propofol-fentanyl versus propofol alone for lumbar puncture sedation in children with acute acute lymphoblastic leukemia: propofol dosing and adverse events. Pediatr Crit Care Med 2008;9(6): 616–622.
25. Hooke MC, Grund E, Quammen H, Miller B, McCormick P, Bostrom B. Propofol use in pediatric patients with severe cancer pain at the end of life. J Pediatr Oncol Nurs 2007;24(1):29-34.
26. David H, Shipp J. A randomized controlled trial of ketamine/propofol versus propofol alone for emergency department procedural sedation. Ann Emerg Med 2011;57(5):435-41.
27. Bajwa SJS, Bajwa SK, Kaur J. Comparison of two drug combinations in total intravenous anesthesia: Propofol–ketamine and propofol–fentanyl. Saudi J Anaesth 2010;4(2):72-9.
28. Shetabi H, Golparvar M, Ghanbardezfoli S, Torfenejad M. Sedative and analgesic efficacy of propofol-ketamine and propofol remifentanil during painful procedures in children with acute lymphoblastic leukemia. Iran J Ped Hematol Oncol 2018;8(2):87-96
29. Shetabi H, Shafa A, Zare M. Effect of Ketamine-Sufentanil and Ketamine-Midazolam to induce sedation and analgesia in pediatric with Lumbar Puncture or Bone Marrow Aspiration. AACC 2018;4(3):497-500.
30. Shetabi H, Asadi N, Golparvar M, Shafa A. The Comparison of the Effect of Ketamine-Sufentanil Combination and Propofol-Remifentanil Combination on the Quality of Sedation during Painful Procedures in Children with Hematological Malignancies. J Isfahan Med Sci 2018; 36(480):548-56.
| Files | ||
| Issue | Vol 6, No1-2 (Winter 2018) | |
| Section | Original Article(s) | |
| Keywords | ||
| Acute Lymphoblastic Leukemia Ketamine Sufentanil | ||
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How to Cite
1.
Shetabi H, Shafa A, Golparvar M, Mohammadi Nasab J. Comparison Effect of Intravenous Ketamine with Sufentanil for Pain Relief during Painful Procedures in Children with Leukemia. J Pharm Care. 2018;6(1-2):3-8.
