Low dose fentanyl infusion versus 24% oral sucrose for pain management during laser treatment for retinopathy of prematurity—an open label randomized clinical trial

Sethi, Amanpreet; Sankar, Mari Jeeva; Kulkarni, Srikanth; Thukral, Anu; Chandra, Parijat; Agarwal, Ramesh

doi:10.1007/s00431-019-03514-5

Cited by 10 publications

(6 citation statements)

References 16 publications

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“…Rationale: Nonnutritive sucking with oral sucrose and expressed breast milk have been well studied in the NICU population (83,86,(91)(92)(93)(94)(95)(96)(97)(98). The use of oral sucrose has had the biggest effect in some studies, but combinations of all nonnutritive suck techniques with swaddling have shown additive effects on pain reduction during heel stick procedures with no AEs reported among infants (99)(100)(101).…”

Section: Pharmacologic Management Of Painmentioning

confidence: 99%

2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility

Smith

Besunder

Betters

et al. 2022

Pediatric Critical Care Medicine

245

212

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RATIONALE:A guideline that both evaluates current practice and provides recommendations to address sedation, pain, and delirium management with regard for neuromuscular blockade and withdrawal is not currently available. OBJECTIVE:To develop comprehensive clinical practice guidelines for critically ill infants and children, with specific attention to seven domains of care including pain, sedation/agitation, iatrogenic withdrawal, neuromuscular blockade, delirium, PICU environment, and early mobility. DESIGN:The Society of Critical Care Medicine Pediatric Pain, Agitation, Neuromuscular Blockade, and Delirium in critically ill pediatric patients with consideration of the PICU Environment and Early Mobility Guideline Taskforce was comprised of 29 national experts who collaborated from 2009 to 2021 via teleconference and/or e-mail at least monthly for planning, literature review, and guideline development, revision, and approval. The full taskforce gathered annually in-person during the Society of Critical Care Medicine Congress for progress reports and further strategizing with the final face-to-face meeting occurring in February 2020. Throughout this process, the Society of Critical Care Medicine standard operating procedures Manual for Guidelines development was adhered to. METHODS:Taskforce content experts separated into subgroups addressing pain/ analgesia, sedation, tolerance/iatrogenic withdrawal, neuromuscular blockade, delirium, PICU environment (family presence and sleep hygiene), and early mobility. Subgroups created descriptive and actionable Population, Intervention, Comparison, and Outcome questions. An experienced medical information specialist developed search strategies to identify relevant literature between January 1990 and January 2020. Subgroups reviewed literature, determined quality of evidence, and formulated recommendations classified as "strong" with "we recommend" or "conditional" with "we suggest. " Good practice statements were used when indirect evidence supported benefit with no or minimal risk. Evidence gaps were noted. Initial recommendations were reviewed by each subgroup and revised as deemed necessary prior to being disseminated for voting by the full taskforce. Individuals who had an overt or potential conflict of interest abstained from relevant votes. Expert opinion alone was not used in substitution for a lack of evidence. RESULTS:The Pediatric Pain, Agitation, Neuromuscular Blockade, and Delirium in critically ill pediatric patients with consideration of the PICU Environment and Early Mobility taskforce issued 44 recommendations (14 strong and 30 conditional) and five good practice statements.

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Section: Pharmacologic Management Of Painmentioning

confidence: 99%

2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility

Smith

Besunder

Betters

et al. 2022

Pediatric Critical Care Medicine

245

212

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“…[ 70 ] Table 6 illustrates reviewed sedoanalgesia articles during ROP treatment. [ 60 62 63 64 65 66 68 69 70 71 72 73 74 75 ]…”

Section: R Etinopathy Of P Rematurity ...mentioning

confidence: 99%

Anesthesia in retinopathy of prematurity

Alselaimy

Tawil

Abouammoh

2022

Saudi Journal of Ophthalmology

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Retinopathy of prematurity (ROP) remains among the leading causes of childhood blindness. It affects mainly premature infants who tend to be systematically and clinically unstable and are more prone to complications and anesthesia related adverse effects when undergoing examination or treatment. A better comprehension of different analgesic and anesthetic methods used during screening and treatment may help in choosing a suitable option for ROP screening and treatment. An electronic search was done using MEDLINE, PubMed, and Embase databases. Search terms used included ROP, ROP, ROP screening, ROP treatment, analgesia, and anesthesia. All randomized clinical trials, large case series, and surveys were included in the review. Topical proparacaine is the most commonly used anesthesia during ROP screening and may significantly ease pain during ROP screening. Different comfort measures during screening may help infants recover faster but do not abolish pain. Topical tetracaine seems an effective pain-relieving option during intravitreal injections for ROP treatment. Photocoagulation of the peripheral retina under general anesthesia is considered the most common practice in the treatment of ROP. Further work is necessary to better understand the options of anesthesia methods offered for the treatment of ROP patients. This is a comprehensive review highlighting the available anesthetic methods for ROP patients to aid ophthalmologists in determining the most common and current anesthetic and analgesic practices.

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“…There is lack of high-quality data from low-income to middle-income countries regarding pain relief during treatment for ROP. We chose fentanyl and ketamine because the previous Randomised Controlled Trial (RCT) from the same unit by Sethi et al 13 failed to demonstrate adequate analgesia with low dose fentanyl infusion without bolus as well as oral dextrose.…”

Section: Open Accessmentioning

confidence: 99%

“…Kataria et al in his RCT demonstrated that oral dextrose hardly provided any analgesia compared with a placebo. 23 In the previous RCT from our own unit, Sethi et al 13 used a continuous fentanyl infusion of 1 µg/kg/ hour without any prior bolus and reported mean PIPP-R scores of 7.2 (±1.1) and proportion of time spent crying during procedure of 62.5% (95% CI 50.7% to 74.2%) indicating poor control of the pain. The regimens in our study provided better control of pain compared with the regimen used in previous study but still fell considerably short of achieving adequate analgesia in majority of the infants.…”

Section: Strengths and Weaknesses In Relation To Other Studiesmentioning

confidence: 99%

“…Recently, we conducted a randomised trial comparing intravenous fentanyl (continuous infusion of 1 µg/kg/hour throughout the procedure) and oral 24% dextrose in providing analgesia to the infants undergoing laser photocoagulation. 13 The study found that fentanyl was superior to 24% dextrose in reducing the pain. However, on post hoc analysis of study data for adequate analgesia (as defined in the present study: Premature Infant Pain Profile-Revised (PIPP-R) less than 7 and proportion of the procedure time the infant spent crying less than 5%), we found that none of the enrolled infants (0/58, 0%) had adequate analgesia during the procedure.…”

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

‘NOPAIN-ROP’ trial: Intravenous fentanyl and intravenous ketamine for pain relief during laser photocoagulation for retinopathy of prematurity (ROP) in preterm infants: A randomised trial

et al. 2021

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ObjectivesTo investigate if intravenous fentanyl or intravenous ketamine can provide adequate analgesia in preterm infants undergoing laser photocoagulation for retinopathy of prematurity (ROP).DesignOpen-label randomised trial.SettingTertiary care institution.ParticipantsPreterm infants who underwent laser photocoagulation for ROP.InterventionsInfants were randomised to receive fentanyl as intravenous bolus dose of 2 µg/kg, followed by an intravenous infusion of 1 µg/kg/hour increased to a maximum of 3 µg/kg/hour or intravenous ketamine as bolus dose of 0.5 mg/kg, followed by further intermittent intravenous bolus doses of 0.5 mg/kg to a maximum of 2 mg/kg in the initial phase and intravenous fentanyl (bolus of 2 µg/kg followed by infusion of 2 µg/kg/hour to a maximum of 5 µg/kg/hour) or intravenous ketamine (bolus dose of 1 mg/kg followed by intermittent bolus doses of 0.5 mg/kg to a maximum of 4 mg/kg) in the revised regimen phase.Main outcome measuresProportion of infants with adequate analgesia defined as the presence of both: (1) all the Premature Infant Pain Profile-Revised scores measured every 15 min less than seven and (2) proportion of the procedure time the infant spent crying less than 5%.Secondary outcomes included apnoea, cardiorespiratory or haemodynamic instability, feed intolerance and urinary retention requiring catheterisation during and within 24 hours following the procedure.ResultsA total of 97 infants were randomised (fentanyl=51, ketamine=46). The proportions of infants with adequate analgesia were 16.3% (95% CI 8.5% to 29%) with fentanyl and 4.5% (95% CI 1.3% to 15.1%) with ketamine. Ten infants (19.6%) in the fentanyl group and seven infants (15.2%) in the ketamine group had one or more side effects. In view of inadequate analgesia with both the regimens, the study steering committee recommended using a higher dose of intravenous fentanyl and intravenous ketamine. Consequently, we enrolled 27 infants (fentanyl=13, ketamine=14). With revised regimens, the proportions of infants with adequate analgesia were higher: 23.1% (95% CI 8.2% to 50.2%) with fentanyl and 7.1% (95% CI 1.3% to 31.5%) with ketamine. However, higher proportions of infants developed apnoea (n=4; 30.7%), need for supplemental oxygen (n=5, 38.4%) and change in cardiorespiratory scores (n=7; 53.8%) with fentanyl but none with ketamine.ConclusionsFentanyl-based and ketamine-based drug regimens provided adequate analgesia only in a minority of infants undergoing laser photocoagulation for ROP. More research is needed to find safe and effective regimens that can be employed in resource constrained settings.Trial registration numberCTRI/2018/03/012878.

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Low dose fentanyl infusion versus 24% oral sucrose for pain management during laser treatment for retinopathy of prematurity—an open label randomized clinical trial

Cited by 10 publications

References 16 publications

2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility

2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility

Anesthesia in retinopathy of prematurity

‘NOPAIN-ROP’ trial: Intravenous fentanyl and intravenous ketamine for pain relief during laser photocoagulation for retinopathy of prematurity (ROP) in preterm infants: A randomised trial

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