Fentanyl as pre-emptive treatment of pain associated with turning mechanically ventilated patients: a randomized controlled feasibility study

Purpose To compare pain incidence and changes in pain scores with fentanyl versus placebo as pre-emptive treatment during turning and 30 min post-turning in mechanically ventilated critically ill patients. Methods We performed a randomized, double-blind, parallel-group, placebo-controlled clinical t...

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Bibliographic Details
Published in:Intensive care medicine 2016-02, Vol.42 (2), p.183-191
Main Authors: Robleda, Gemma, Roche-Campo, Ferran, Sendra, Maria-Àngels, Navarro, Marta, Castillo, Ana, Rodríguez-Arias, Ainhoa, Juanes-Borrego, Elena, Gich, Ignasi, Urrutia, Gerard, Nicolás-Arfelis, José M., Puntillo, Kathleen, Mancebo, Jordi, Baños, Josep E.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Analgesics, Opioid - therapeutic use
Anesthesiology
Care and treatment
Central nervous system depressants
Clinical trials
Critical Care - methods
Critical Care Medicine
Double-Blind Method
Emergency Medicine
Feasibility Studies
Female
Fentanyl
Fentanyl - therapeutic use
Guardians
Hospital patients
Hospitals
Humans
Injections, Intravenous
Intensive
Intensive care
Male
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
Middle Aged
Moving and Lifting Patients - adverse effects
Narcotics
Nursing
Original
Pain
Pain - drug therapy
Pain - etiology
Pain Medicine
Patients
Pediatrics
Pneumology/Respiratory System
Respiration, Artificial - adverse effects
Ventilators
Young Adult
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Summary:Purpose To compare pain incidence and changes in pain scores with fentanyl versus placebo as pre-emptive treatment during turning and 30 min post-turning in mechanically ventilated critically ill patients. Methods We performed a randomized, double-blind, parallel-group, placebo-controlled clinical trial in the intensive care unit of a university hospital. Seventy-five mechanically ventilated patients were randomized to an intervention group (fentanyl) or a control group (placebo). Patients in the intervention group received 1 µg/kg (medical patients) or 1.5 µg/kg (surgical patients) of fentanyl 10 min before turning. Pain indicators were assessed using the behavioral pain scale. Safety was assessed by determining the frequency and severity of pre-defined adverse events. Pain was evaluated at rest (T0), at turn start and end (T1 and T2) and at 5, 15 and 30 min post-turning (T3, T4 and T5). Results The two groups had similar baseline characteristics. The area under the curve for BPS values was significantly smaller in the fentanyl group than in the control group [median and interquartile range (IQR): 132 (108–150) vs. 147 (125–180); p  = 0.016, respectively]. Nineteen non-serious adverse events were recorded in 14 patients, with no significant between-group differences (23 % fentanyl group vs. 14 % control group; p  = 0.381). Conclusions These results suggest an intravenous bolus of fentanyl of 1 µg/kg for medical patients or 1.5 µg/kg for surgical patients reduces the incidence of turning-associated pain in critically ill patients on mechanical ventilation. ClinicalTrials.gov: NCT 01950000.
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-015-4112-7