Association between fentanyl test results and rescue morphine requirements in children after adenotonsillectomy

Abstract

Purpose

Preoperative sleep study helps to predict post-adenotonsillectomy morphine requirements. However, in some institutions, many suspected children with obstructive sleep apnoea syndrome have an adenotonsillectomy without polysomnography assessments. This study investigated the relationship between the results of a fentanyl test performed before extubation and the postoperative morphine requirements in children after adenotonsillectomy.

Methods

Intravenous fentanyl (1 µg/kg) was given as a test before extubation when spontaneous ventilation was restored in 80 children aged 3–7 years who underwent adenotonsillectomy. The result was considered positive if the patient’s respiratory rate decreased >50% after the test. In the recovery room, pain was assessed every 10 min using the Children’s Hospital of Eastern Ontario Pain Scale. Rescue morphine (10 µg/kg) was given when the score was ≥6.

Results

The median [IQR (range)] cumulative morphine consumption rates for children with a positive result (n = 25) and a negative result (n = 52) were 30 (20, 40) and 50 (40, 50) µg/kg, respectively (P = 0.002). Eighty-eight percent of the positive-result patients and 48% of the negative-result patients were light consumers of morphine (cumulative dose <50 µg/kg) (P = 0.001).

Conclusions

We conclude that children with a positive result after a fentanyl test require less morphine to achieve comfort than those with a negative result.

ClinicalTrials.gov ID

NCT02484222.