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

Gemma Robleda, Ferran Roche-Campo, Maria Àngels Sendra, Marta Navarro, Ana Castillo, Ainhoa Rodríguez-Arias, Elena Juanes-Borrego, Ignasi Gich, Gerard Urrutia, José M. Nicolás-Arfelis, Kathleen Puntillo, Jordi Mancebo, Josep E. Baños

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Abstract

© 2015, Springer-Verlag Berlin Heidelberg and ESICM. 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.
Original languageEnglish
Pages (from-to)183-191
JournalIntensive Care Medicine
Volume42
Issue number2
DOIs
Publication statusPublished - 1 Feb 2016

Keywords

  • Behavioral pain scale
  • Intensive care unit
  • Mechanical ventilation
  • Pain
  • Pre-emptive analgesia
  • Turning

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    Robleda, G., Roche-Campo, F., Sendra, M. À., Navarro, M., Castillo, A., Rodríguez-Arias, A., Juanes-Borrego, E., Gich, I., Urrutia, G., Nicolás-Arfelis, J. M., Puntillo, K., Mancebo, J., & Baños, J. E. (2016). Fentanyl as pre-emptive treatment of pain associated with turning mechanically ventilated patients: a randomized controlled feasibility study. Intensive Care Medicine, 42(2), 183-191. https://doi.org/10.1007/s00134-015-4112-7