[Comparing the effects of IV and intranasal midazolam administration on pain, anxiety and fear of children undergoing painful invasive procedures]

ABSTRACT

Among children, there are several painful diagnostic or therapeutic procedures especially in malignant disease which may evoke fear and anxiety that may interfere with the treatment. Due to various reports on the efficacy of midazolam, we compared the effects of intranasal versus intravenous midazolam in reducing the pain, fear, and anxiety in children undergoing painful procedures at Loghman hospital between 2005-2006. This randomized clinical trial was conducted on two 30-participant groups of patients aged 4-15 years who were to underwent painful procedures [including bone marrow aspirations and lumbar punctures]. One group received intravenous Midazolam and the other one did intranasal Midazolam before the procedures. Pain was measured based on Bieri facial pain scale, whereas anxiety was determined based on Yale-Pas scale. Fear was measured and analyzed between the two groups by Chi-square and fisher's exact tests. Side affects were documented in both groups as well. 50% of patients in the IV group, and 53.3% in the intranasal group had the Yale-PAS anxiety score of above 37, which was yielding a significant difference [P<0.9]. 90% of the subjects in the intranasal group had mild pain while 10% had moderate one. In the IV group 74% experienced a mild pain and 25.9% suffered from moderate pain, whereas 10% experienced none at all. No significant difference was observed between the levels of pain amongst two groups [P<0.9]. In both groups fear bacame less during and after the procedure and it was significantly decreased in intranasal group. Since the effect of intranasal and IV Midazolam on reducing the pain, anxiety, and fear is not significantly different, regarding the simplicity of intranasal administration, this approach may be of further compliance and more practicality for analgesia of painful procedures