• S J Weisman, B Bernstein, and N L Schechter.
• Department of Anesthesiology, Yale University School of Medicine, New Haven, Conn, USA.
• Arch Pediat Adol Med. 1998 Feb 1;152(2):147-9.

ObjectiveTo explore the effect of inadequate analgesia for painful procedures (bone marrow aspiration, lumbar puncture, or both) on the pain of subsequent procedures.DesignA cohort of patients with cancer who had participated in a placebo-controlled, randomized study that documented the efficacy of oral transmucosal fentanyl citrate for painful procedures rated the pain associated with subsequent procedures performed with open-label oral transmucosal fentanyl.ParticipantsTwenty-one children undergoing diagnostic procedures who had been participants in previous study.InterventionAll children were given oral transmucosal fentanyl, 15 to 20 microgram/kg, prior to the procedure; at its conclusion they were asked to rate the associated pain.ResultsIn children younger than 8 years (n = 13), mean pain ratings during each subsequent procedure were consistently higher for those who had received placebo (n = 8) in the original study compared with those who had received the active drug (n = 5). A repeated-measures analysis of variance suggests that this difference is statistically significant (P = .04). Older children (n = 8) did not show this pattern.ConclusionInadequate analgesia for initial procedures in young children may diminish the effect of adequate analgesia in subsequent procedures.

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