Resumo

CANOVAS, L. et al. Analgesia with oral transmucosal fentanyl citrate (OTFC) for painful pediatric procedures. Rev. Soc. Esp. Dolor [online]. 2004, vol.11, n.7, pp.35-39. ISSN 1134-8046.

Introduction: The aim of this study was to determine the analgesic-sedative effectiveness, the incidence of side effects and the plasma levels of oral fentanyl citrate for painful procedures performed in children weighting more than 15 kg. Oral transmucosal fentanyl critate was approved by the FDA in 1993 for children >10 kg. Method: The study was designed to include 25 children aged 3-10 years, divided in two groups according to the painful procedure. Burned patients that were given OTFC 10-15 mg.kg-1 30 minutes before the dressing of their wounds were included in group 1 (n = 5). Group 2 (n = 20) included patients with greenstick fractures that received OTFC 10-15 mg.kg-1 30 minutes prior to fracture repair. The study variables were: level of sedation using a 1-5 scale; analgesic effectiveness using a 0-5 simple scale of facial or verbal icons according to the age of the patient; incidence of desaturation, considered as a 5% decrease lasting more than 30 seconds; drug plasma levels measured at 15-minute intervals after intake over a period of 90 minutes; need for rescue analgesia (morphine chloride 0,1 mg.kg-1 if VAS > 3). Results: Consumption of OTFC was completed within the same period of time in both groups (14.3 ± 6.2/13.8 ± 4.1 min). Sedation became evident in both groups after 20 minutes (1-3: 2/8; 4-5: 3/12). The final VAS obtained in both groups was bellow 2. There was no desaturation event, no nauseas and no need for rescue analgesia. Peak plasma levels were reached in both groups after 45 minutes (1.04± 0.42 ng.ml-1/1.05 ± 0.39 ng.ml-1), but similar levels were found after 30-60 minutes, which suggests a large drug intake. Conclusions: OTFC as a sedative analgesic drug was effective in all the patients. No cases of nausea or vomiting were reported. All patients in group 2 were discharged three hours after the procedure. The variability in the time elapsed until reaching drug plasma peak levels makes it difficult to determine the optimal interval between the administration of OTFC and the beginning of the painful procedure. This can be explained in children because of their tendency to swallow the drug instead of sucking it, hence prevailing the slower effect due to gastrointestinal absorption over the quick effect obtained with oral transmucosal absortion.

Palavras-chave : Sedative analgesic drug; Fentanyl citrate; Pediatric population.

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