A study on the analgesic effects and safety of continuous intravenous infusion of fentanyl in laser photocoagulation for retinopathy of prematurity

Abstract

Objective To study the safety and efficacy of continuous intravenous infusion of fentanyl in laser photocoagulation of retinopathy of prematurity (ROP). Methods From March, 2014 to January, 2015, ROP infants hospitalized for laser photocoagulation in Guangdong Women and Children hospital were randomly (using envelope method)assigned into the fentanyl groupand the control group.In the fentanyl group, the patients were given fentanyl combined with topical anesthesia, while onlytropical anesthesiain the control group. Premature infant pain profile (PIPP)scores, heart rate, mean artery pressure and complications within 3 days after operation were recorded. The concentration of epinephrine, norepinephrine and cortisol in the blood were measured before and afterthe operation. Student's t test, non-parameter rank and chi-square test were used to compare the differences between the two groups. Results A total of 82 infants were enrolled in the study, 42 in the fentanyl group and 40 in the control group.In the fentanyl group, 11.9% infants had maximum PIPP score ≥6 and 70.0% in the control group, the difference was statistically significant (P<0.05). In the fentanyl group, the PIPP score at the beginning of operation, the maximum PIPP score during operation and the PIPP score at the end of operation were 2.0, 3.0and 1.5, respectively. In the control group, these scoreswere 8.0, 8.0and 8.0 respectively. The differences were statistically significant (P<0.05). No significant differences existed between the concentration of epinephrine, norepinephrine and cortisol before and after operationin the fentanyl group.However, these concentrations were elevated after the operation than before the operation in the control group (P<0.05). The incidence of complications within three days after operation was 19.0% in the fentanyl group and 40.0% in the control group, and the difference was statistically significant (P<0.05). Conclusion Comparing with topical anesthesia, fentanyl combined with topical anesthesia has lower pain scores, less stress responses and fewer complications during ROP laser photocoagulation. Fentanyl combined with topical anesthesia is a safe and effective analgesic method during ROP laser photocoagulation. Key words: Retinopathy of prematurity; Analgesia; Laser coagulation; Stress, physiological