COMPARISON OF ORAL TRANSMUCOSAL FENTANYL CITRATE AND INTRAMUSCULAR MEPERIDINE, PROMETHAZINE, AND CHLORPROMAZINE FOR CONSCIOUS SEDATION OF CHILDREN UNDERGOING LACERATION REPAIR

Study objective: To compare oral transmucosal fentanyl citrate (OTFC) with IM meperidine, promethazine, and chlorpromazine (MPC) for conscio us sedation of children. Methods: This prospective, randomized, single -blinded study involved a convenience sample of 40 children, 3 to 8 ye ars of age, who presented to an urban pediatric emergency department a nd required laceration repair. Patients were premedicated with either OTFC (10 to 15 mu g/kg) and a mock injection or intramuscular MPC (2 m g/kg meperidine, .5 mg/kg promethazine, and .5 mg/kg chlorpromazine) f ollowed by a placebo lozenge. Results: Both OTFC and MPC caused signif icant reductions in activity scores at 15 to 75 minutes after medicati on administration. Although the MPC group was more sedated, there was no difference between groups in Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) scores during the laceration repair or in the sut uring physician's assessment of sedation quality (rated excellent or g ood for 75% and 69% of OTFC and MPC groups, respectively). Two childre n (both in the OTFC group) had oxygen saturation levels of less than 9 5% but required only transient supplemental oxygen. Other adverse even ts were common but not serious; they differed between groups in type b ut not number, with vomiting in 45% of the OTFC group and prolonged so mnolence in 37% of the MPC group. Mean time to discharge was 99 minute s, with no difference between groups. Conclusions: Both medications re duced activity significantly. Although MPC caused deeper sedation, the medications had comparable effects on patient behavior during the rep air and yielded comparable ratings of physician satisfaction. Large nu mbers of nonserious adverse events occurred in both groups.