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Steven J. Weisman, MD; Bruce Bernstein, PhD; Neil L. Schechter, MD

Arch Pediatr Adolesc Med. 1998;152:147-149.

Objective  To explore the effect of inadequate analgesia for painful procedures (bone marrow aspiration, lumbar puncture, or both) on the pain of subsequent procedures.

Design  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.

Participants  Twenty-one children undergoing diagnostic procedures who had been participants in a previous study.

Intervention  All children were given oral transmucosal fentanyl, 15 to 20 µg/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.

Conclusion  Inadequate analgesia for initial procedures in young children may diminish the effect of adequate analgesia in subsequent procedures.

From the Departments of Anesthesiology and Pediatrics, Yale University School of Medicine, New Haven, Conn (Dr Weisman); Center for Children's Health and Development, St Francis Hospital and Medical Center, Hartford, Conn (Drs Bernstein and Schechter); and Department of Pediatrics, University of Connecticut School of Medicine, Farmington (Drs Bernstein and Schechter).

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