Effects of intravenous ketamine and fentanyl combined with midazolam on analgesia and side effects during paediatric outpatient lithotripsy

Abstract

Extracorporeal shock wave lithotripsy (ESWL) is considered a safe and effective treatment for urolithiasis in children. To decrease the pain experienced by the child is very important. In this study, fentanyl-midazolam combination has been compared to ketamine-midazolam bolus combination in paediatric outpatient lithotripsy.Forty patients were randomly divided into two groups; a ketamine group received 2 mg kg−1 ketamine i.v. 10 min before ESWL, and a fentanyl group received 2 μg kg−1 fentanyl i.v. 3 min before ESWL. All patients received 0.1 mg kg −1 midazolam i.v. 3 min before ESWL for intraoperative sedation. The pain intensity was evaluated by a numeric rating scale (NRS). The degree of sedation was assessed with Observer's Assessment of Alertness/Sedation Scale.A supplemental analgesia with i.v. fentanyl (5 μg) was given if analgesia was inadequate (NRS > 3). Oxygen supplement though a face mask was given when the SpO2 fell below 94%. Side effects, and the time of discharge from the post-anaesthesia room (PAR) were recorded. The criterion of discharge from PAR was absence of any discomfort especially when the patient held up-right.The incidence of oxygen supplement was lower in the ketamine group (1/20) compared with that of the fentanyl group (15/20), p < 0.01. The frequency of dizziness was lower in the ketamine group (1/20) than that in the fentanyl group (17/20), p < 0.01. The discharge time from PAR was significantly shorter in the fentanyl group (20.4 ± 6.2 min) than that in the ketamine group (39.5 ± 14.6 min), p < 0.01.Both intravenous ketamine and fentanyl in combination with midazolam could provide good anaesthesia. However, ketamine plus midazolam combination has less side effects in children.