Comparison of the effects of pretreatment intravenous fentanyl or intravenous lidocaine on suppression of fentanyl-induced cough in children: a randomized, double-blind, controlled clinical trial

Abstract

Background and aimThe injection of fentanyl usually causes coughing during induction of anesthesia. Based on a few studies about effects of lidocaine and the fact there is no study concerning the effect of fentanyl on fentanyl-induced cough in pediatric patients, the aim of this study was to compare the effectiveness of low dose of fentanyl with lidocaine in prevention of fentanyl-induced cough in children.MethodsThis randomized double-blind controlled clinical trial study was conducted at Motahari Hospital between February and August 2017 in Urmia (Iran). One hundred patients, aged 2–10 years, of class I or II ASA status who were candidates for elective herniorrhaphy under general anesthesia were enrolled in this study. They were randomly divided into three groups. One minute before the administration of 2 μg/kg fentanyl during induction of general anesthesia, Group I received 1.0 mg/kg lidocaine (n=33), Group II received 0.5 μg/kg fentanyl (n=34) and Group III received normal saline as a control group (n=33). The data were analyzed by STAT version 13. The incidence and severity of cough were determined across groups by using ANOVA and Chi-square tests. Multiple logistic regression was also used to examine the association between the outcome of cough incidence and clinical interventions as the exposures after adjusting for study covariates.ResultsThe highest incidence of cough was found in the Group III (54.5%) versus 32.4% and 21.1% in Group II and Group I subsequently (p=0.02). We have also found significant difference in the incidence of cough among group one and three (p=0.005), and among group two and three (p=0.045). No statistically significant difference has been detected between group one and two. The severity of cough was significantly higher in Group III compared to Groups I and II (p=0.01). The time of onset of cough was similar across groups. No side effects were reported after intervention in this studyConclusionThis study found that pretreatment with fentanyl 0.5mg/kg or 1mg/kg lidocaine is an effective approach to reducing the incidence and severity of fentanyl-induced cough in children.Trial registrationThe trial was registered at the Iranian Registry of Clinical Trials (http://WWW.irct.ir) with IRCT number: IRCT2016112027677N5.FundingThis study was not granted or funded by any institution.

Mechanism and Management of Fentanyl-Induced Cough

“…Several studies have demonstrated that the incidence of FIC is higher in infants and young children ( Golmohammadi et al, 2018 ; Han et al, 2010 ). Young age is one of the important factors for the occurrence of FIC.…”

“…According to the above-mentioned factors related to FIC, the prevention and treatment of FIC can start from the administration of the drug itself, for instance, adjusting the dose and/or concentration of fentanyl analogs, reducing the speed of administration, and selecting appropriate administration routes (such as peripheral administration, etc.). It has also been found that pre-injection of low-dose fentanyl (0.5 μg⋅kg −1 or 25 μg directly) can alleviate FIC to some extent ( Du et al, 2014 ; Golmohammadi et al, 2018 ; Hung et al, 2010 ; Shrestha et al, 2012 ). Pretreatment with a small dose of remifentanil 0.3 μg⋅kg −1 , 1 min before sufentanil injection can effectively and safely reduce the incidence of cough induced by sufentanil (4.8% vs. 31%) ( Lin et al, 2019 ).…”

Premedication with Dexamethasone and Propofol to Control Fentanyl-Induced Cough

“…Even though there are several hypothesis and still the mechanism of FIC is unknown. Different drugs have been studied on FIC with resulted in variable reduction in incidences of FIC .While some physical factors like age 13 , ethnicity 14 and history of smoking 15 may also effect FIC. It has been studied that Asian people are more sensitive to fentanyl and its analogs.…”

Comparing the different oxycodone doses of prevent oxycodone for prevention of preventing fentanyl‐induced cough during induction of general anaesthesia

“…1,2 It is generally transitory and limited; however, it is undesirable in patients with underlying diseases, such as cerebral aneurysm, brain trauma, and hernia, dissecting aortic aneurysm, pneumothorax or reactive airway disease. 3 This is because it can not only cause rapid changes in body hemodynamics, induce cardiovascular and cerebrovascular accidents, but also increase intra-abdominal pressure and increase reflux and aspiration. 4 Although the FIC mechanism has not been fully clarified, different strategies or methods should be used to intervene, thereby reducing the occurrence or relieving this side effect.…”

“…However, FIC is often reported after intravenous fentanyl administration, and it has an incidence between 35% and 64% 1,2 . It is generally transitory and limited; however, it is undesirable in patients with underlying diseases, such as cerebral aneurysm, brain trauma, and hernia, dissecting aortic aneurysm, pneumothorax or reactive airway disease 3 . This is because it can not only cause rapid changes in body hemodynamics, induce cardiovascular and cerebrovascular accidents, but also increase intra‐abdominal pressure and increase reflux and aspiration 4 .…”