Efficacy of fentanyl on pain relief during tracheal suctioning in ventilated children: A randomized clinical trial

Abstract

Background: Tracheal suctioning by the time of mechanical ventilation is an important necessary procedure associated with pain, but there is no standard treatment for pain control during tracheal suctioning in ventilated children. Here we investigated the effectiveness of fentanyl injection on pain intensity in children undergoing tracheal suctioning. Methods: This is a double-blinded randomized clinical trial that was performed during 2020 in a tertiary pediatric intensive care unit (PICU) on 50 children under mechanical ventilation. Demographic data of all patients, including age, gender, the reason for admission and mechanical ventilation duration, and also the continuous infusion dose of fentanyl and midazolam were collected. Furthermore, we measured pain with FLACC scale (face - leg -activity - cry - consolability) and physiologic indices (heart rate and systolic and diastolic arterial pressure, respiratory rate, and oxygenation saturation) by the time of tracheal suctioning. Patients were randomly divided into two groups receiving 1 mu g/kg fentanyl as an analgesic or normal saline as a placebo. The drugs were administered before tracheal suctioning, and the pain score and physiologic indices were measured, and changes were evaluated. Results: administration of 1 mu g/kg fentanyl in ventilated children before tracheal suctioning is associated with no significant changes in pain frequency and severity measured by FLACC behavioral score (P > 0.05). We observed increased vital signs O2 saturation, respiratory rate, pulse rate, mean arterial pressure in all patients (P < 0.001 for all items), but the mean changes were higher in the placebo group. Conclusion: Administration of 1 mu g/kg fentanyl for pain relief in ventilated children during tracheal suctioning is associated with no significant differences on pain frequency and severity based on the FLACC behavioral scale, but we observed lower changes in physiologic parameters after tracheal suction in fentanyl injection group. We suggest that more studies should be performed on the different dosages of fentanyl in combination with other analgesic drugs, higher sample size, and sample with pre-suction pain and distress control. (C) 2022 Elsevier Ltd. All rights reserved.