Sedative and Analgesic efficacy of Propofol-Ketamine and Propofol- Remifentanil During Painful Procedures in Children with Acute Lymphoblastic Leukemia

Background: Lumbar puncture (LP) and bone marrow aspiration or biopsy in pediatric patients with hematological diseases is often repeated at regular intervals. These procedures are painful and unpleasant and bring a lot of stress for the children and their families. This study aimed to compare the effectiveness of two drug combinations of propofol-ketamine and propofol-remifentanil in children with acute lymphoblastic leukemia under bone marrow aspiration or biopsy and lumbar puncture (LP). Materials and Methods: In this clinical trial, 81 children aged 6 months to 14 years old with acute lymphoblastic leukemia who were candidates for lumbar puncture, bone marrow aspiration or biopsy were randomly divided into two groups of receiving Propofol-Ketamine and receiving Propofol-Remifentanil. In each group, hemodynamic indices, sedation, side effects, the onset of effectiveness and duration of remaining in the recovery room were measured and recorded. Data were analyzed using Chi square test, Mann-Whitney, independent t-test, and Fisher’s exact test with a significant level of p<0.05. Results: The need for repeating drug’s dosage was significantly lower in the group received Propofol-Ketamine than the other group (p=0.009). The mean of systolic blood pressure and arterial oxygen saturation at the end of the procedure was significantly lower in the Propofol-Remifentanil receiving group (respectively p=0.040 and p=0.001). During the procedure, the frequency of hypotension was significantly higher in the Propofol- Remifentanil receiving group (p=0.048). The recovery duration was reported significantly longer for the Propofol-Ketamine receiving group (p=0.004). Sedation indices, other hemodynamic indices, and the onset of effectiveness caused no significant difference between two groups (p>0.05). Conclusion: It seems that the combination of Propofol-Ketamine could be a more appropriate combination in children especially in patients with unstable hemodynamics due to lower need for repetition of the drug dose and more hemodynamic stability.