The Clinical Effect of Fentanyl in Comparison with Ketamine in Analgesic Effect for Oncology Procedures in Children: A Randomized, Double-Blinded, Crossover Trial
Chalinee Monsereenusorn MD*, Piya Rujkijyanont MD*, Chanchai Traivaree MD, MSc*
Affiliation : * Division of Hematology/Oncology, Department of Pediatrics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
Background : Children often require relief of pain and anxiety when undergoing painful procedures.
Objective : To determine the differences by comparing fentanyl and ketamine used in cancer-diagnosed children undergoing
painful procedures.
Material and Method: A randomized, double-blinded, crossover trial was conducted with 55 children undergoing painful
procedures (intrathecal chemotherapy and/or bone marrow aspiration/biopsy). Patients were randomly assigned in a
double-blinded fashion to receive either intravenous fentanyl or ketamine at 1 mcg/kg/dose and 1 mg/kg/dose, respectively.
The result in effectiveness of the drug was measured using three parameters, 1) satisfaction score ranging from 0 to 10,
2) perception of procedural pain using FLACC scale, Wong-Baker FACES Pain Rating Scale and Visual Analog Scale, and
3) the frequency of vomiting nausea score.
Results : The satisfaction among patients receiving fentanyl was significantly greater than ketamine (p = 0.007). In addition,
both painful and nausea/vomiting were significantly decreased in the patients receiving fentanyl (p = 0.002 and p<0.001,
respectively). No serious complications were observed.
Conclusion : This study demonstrated that intravenous fentanyl generated a superior clinical effect in satisfaction, decreased
pain and nausea/vomiting, and showed no significant side-effects over ketamine. Fentanyl may also be recommended as a
reasonable option before undergoing oncology procedures in children with cancer.
Keywords : Children with cancer, Satisfaction, Nausea and vomiting, Painful
