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Patient-controlled analgesia with fentanil and midazolam in children with postoperative neurosurgical pain

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Abstract

Background

Pain is the most common discomfort experienced by children undergoing major operations. It is most often not adequately treated because of inexperience and unfounded fears related to the use of opioid drugs. In adults, patient-controlled analgesia (PCA) is widely administered, while in children, its use with opioid drugs is still under evaluation for safety and efficacy.

Objectives

The objective of the study is to evaluate the safety and efficacy of an opioid drug (fentanil) administered by PCA associated with a sedative-adjuvant drug (midazolam) administered by continuous infusion in children having undergone major neurosurgical procedures.

Materials and methods

Sixteen children with moderate to severe postoperative pain were treated with fentanil by PCA (booster doses of 1 μg/kg) plus continuous infusion of midazolam (2 μg/kg per min) by an intravenous route. To evaluate safety and efficacy of this analgesic protocol, different subjective and objective parameters were monitored at 4-h intervals. In addition, patients’ satisfaction was assessed by a questionnaire at the end of the treatment.

Main results

All children experienced a good degree of analgesia and did not require any other analgesic drug during the treatment. Both subjective and objective parameters improved after starting pain-relieving treatment, and no major side effects occurred. The analysis of the answers of the questionnaire administered to the children showed a high grade of satisfaction.

Conclusions

PCA with fentanil plus continuous infusion of midazolam is a safe and efficacious method for analgesia in children with moderate to severe postoperative neurosurgical pain. The association of midazolam to fentanil also contributes to control anxiety and stress in this subset of patients and does not show any important side effects.

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Authors and Affiliations

  1. Pediatric Intensive Care Unit, A. Gemelli Hospital, Catholic University of Rome, Largo A. Gemelli, 8, 00168, Rome, Italy

    Antonio Chiaretti, Orazio Genovese, Alessia Antonelli, Luca Tortorolo & Benedetta Focarelli

  2. Pediatric Oncology, Catholic University of Rome, Rome, Italy

    Antonio Ruggiero

  3. Pediatric Neurosurgery, Catholic University of Rome, Rome, Italy

    Concezio Di Rocco

Authors
  1. Antonio Chiaretti
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  2. Orazio Genovese
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  3. Alessia Antonelli
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  4. Luca Tortorolo
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  5. Antonio Ruggiero
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  6. Benedetta Focarelli
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  7. Concezio Di Rocco
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Correspondence to Antonio Chiaretti.

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Chiaretti, A., Genovese, O., Antonelli, A. et al. Patient-controlled analgesia with fentanil and midazolam in children with postoperative neurosurgical pain. Childs Nerv Syst 24, 119–124 (2008). https://doi.org/10.1007/s00381-007-0429-z

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  • DOI: https://doi.org/10.1007/s00381-007-0429-z

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