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

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 mu g/kg bolus, 1-5 mu g/kg/h infusion) in Group F or dexmedetomidine (1 mu g/kg bolus, 0.2-0.7 mu g/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.