Comparison of sedative and analgesic effects of propofol-ketamine and sufentanil-ketamine combination during bone marrow aspiration and lumbar puncture in children with acute lymphoblastic leukemia.

Background and Aim: Children with hematologic malignancy during the course of illness require diagnostic and therapeutic interventions which are associated with pain and stress. The purpose of this study was to evaluate and compare the sedative and analgesic effects of propofol-ketamine and sufentanil-ketamine during diagnostic and therapeutic interventions in the children. Material and Methods: This randomized, double-blind clinical trial included children with acute lymphoblastic leukemia, between 6 months and 14 years of age, who were candidate for lumbar puncture or bone marrow aspiration. Children were randomly assigned to two groups of 34, propofol-ketamine (PK) and sufentanil-ketamine (SK) groups. PK group received injections of propofol (1 mg/kg) and ketamine (0.7 mg/kg). SK group received injections of sufentanil (0.5 µg/kg) and ketamine (0.7 mg/kg) until the desired sedation level was reached. The two groups were compared with each other in regard to quality of sedation, analgesia and hemodynamic changes during the intervention and in the recovery room. Results: There was no significant difference between the two groups in relation to demographic characteristics,(P> 0.05). The relative frequency of deep sedation levels in the SK group was greater than that in the PK group (P = 0.09). The mean pain severity in the SK group was significantly lower than that in the PK group (P = 0.02). Conclusion: The results of this study showed that use of ketamine with propofol or sufentanil in painful procedures can provide sedation and analgesia. Sufentanil-ketamine is preferred to propofol- Ketamine because of inducing superior quality of sedation and analgesia and also stability of hemodynamic parameters, in children with acute lymphoblastic