# Analgesic and Sedative Effect of Fentanyl Versus Dexmedetomidine Infusion in Postoperative Mechanically Ventilated Children After Open Abdominal Surgeries: Randomized Controlled Trial

## TL;DR

This study compared fentanyl and dexmedetomidine for sedation and pain control in children on ventilators after abdominal surgery, finding each drug had distinct advantages.

## Contribution

The study provides new comparative evidence on sedative and analgesic effects of fentanyl versus dexmedetomidine in postoperative mechanically ventilated children.

## Key findings

- Dexmedetomidine provided better sedation and pain control than fentanyl.
- Fentanyl resulted in faster weaning and extubation times compared to dexmedetomidine.
- Dexmedetomidine caused lower heart rates and blood pressure in the first 24 hours.

## Abstract

Background: Optimal sedation and analgesia management in mechanically ventilated (MV) children post-abdominal surgery remain controversial. This study compared the efficacy and safety of fentanyl versus dexmedetomidine infusion in this population.

Methods: A randomized, double-blinded study enrolled 54 MV children aged 4–11 years post-open abdominal surgeries. Patients received either fentanyl (1 μg/kg bolus, 1–5 μg/kg/h infusion) in Group F or dexmedetomidine (1 μg/kg bolus, 0.2–0.7 μg/kg/h infusion) in Group D. Hemodynamic parameters, sedation (COMFORT-B scale), pain (FLACC scale), and weaning times were assessed.

Results: Group D showed significantly lower mean arterial pressure and heart rates from 6 to 24 h post-intervention (p < 0.05). Oxygen saturation remained similar between groups. Dexmedetomidine provided superior sedation (COMFORT-B: 7 [6–8] vs. 8 [7–8], p=0.022) and analgesia (FLACC: 1 [1–2.5] vs. 2 [2–3], p=0.005). However, dexmedetomidine achieved faster weaning (25.89 ± 2.01 vs. 29.19 ± 1.44 h, p < 0.001) and higher extubation times (51.93 ± 4.84 vs. 43.78 ± 5.32 min, p < 0.001).

Conclusions: While dexmedetomidine offered better sedation and pain control, fentanyl facilitated quicker weaning and extubation from MV and better hemodynamics in postoperative MV children after open abdominal surgeries.

Trial Registration: ClinicalTrials.gov identifier: NCT06994273