A rectally administered combination of midazolam and ketamine was easy, effective and feasible for procedural pain in children with cerebral palsy

Nilsson, Stefan; Brunsson, Ingemar; Askljung, Berit; Påhlman, Magnus; Himmelmann, Kate

doi:10.1111/apa.13710

Cited by 11 publications

(17 citation statements)

References 27 publications

(41 reference statements)

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“…Management of procedural pain was evaluated for ( n =number of studies): intramuscular BoNT‐A injections ( n =5), acupuncture ( n =1), and venepuncture ( n =1) …”

Section: Resultsmentioning

confidence: 99%

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Management of pain in children and adolescents with cerebral palsy: a systematic review

Ostojic

Paget

Morrow

2018

Develop Med Child Neuro

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ABBREVIATIONS BoNT-A Intramuscular botulinum toxin-A VAS Visual analogue scale ITB Intrathecal baclofen AIM To determine the efficacy of interventions for the management of pain in children and adolescents with cerebral palsy (CP). METHOD Electronic databases were searched from the earliest date possible to April 2018 using a mixture of subject headings and free text. Inclusion criteria comprised of studies with (1) diagnosis of CP, (2) under the age of 18 years, (3) intervention for the management of pain, (4) outcome measure of pain, and (5) studies published in English-language peerreviewed journals. RESULTS Fifty-seven studies met the eligibility criteria. Pain related to (n=number of studies): hypertonia (n=17), spastic hip disease (n=13), procedures for the management of CP (n=7), postoperative (n=18), and other (n=2). Most of the studies were of level III to level V evidence.

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“…Management of procedural pain was evaluated for ( n =number of studies): intramuscular BoNT‐A injections ( n =5), acupuncture ( n =1), and venepuncture ( n =1) …”

Section: Resultsmentioning

confidence: 99%

“…Pain during BoNT‐A injections was managed with: inhaled nitrous oxide with topical anaesthetic cream ( n =2); ketamine with midazolam ( n =2); and clown‐care therapy ( n =1) . Observational studies reported mixed evidence for the efficacy of inhaled nitrous oxide with topical anaesthetic cream.…”

Section: Resultsmentioning

confidence: 99%

Management of pain in children and adolescents with cerebral palsy: a systematic review

Ostojic

Paget

Morrow

2018

Develop Med Child Neuro

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“…insertion has to be considered by clinicians for children. As alternative routes, a small number of studies evaluated rectal, 40 , 41 intranasal 42 – 45 and submucosal 46 administration in the paediatric setting ( Table 1 ). The rectal ketamine route was suggested in a clinical trial by Nilsson et al performing sedation and analgesia in 61 children with cerebral palsy).…”

Section: Reviewmentioning

confidence: 99%

Refractory symptoms in paediatric palliative care: can ketamine help?

Benini¹,

Congedi²,

Giacomelli³

et al. 2021

DIC

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Background One of the main challenges for paediatric palliative care (PPC) is the management of concomitant, different and severe symptoms that frequently affect the quality of life of PPC patients and are often refractory to commonly used pharmacological treatments. Consequently, many efforts are still needed to find the best therapeutic options to handle these refractory conditions. Since the first synthesis of ketamine in the 1960s, its pharmacokinetic and pharmacodynamic properties have been largely investigated and its potential wide range of clinical applications has become clear. However, this molecule still receives poor attention in some areas, including in children and PPC. This narrative review analyses the use of ketamine in children and the potential extension of its applications in PPC in order to provide new options for treatment in the PPC setting. Methods Scientific papers published before October 2020 on MEDLINE, EMBASE and the Cochrane Library were considered. The cited references of the selected papers and the authors’ personal collections of literature were reviewed. The terms “palliative care”, “ketamine”, “neuropathic pain”, “procedural pain”, “status epilepticus”, “refractory pain” and “child”, adding “age: birth–18 years” on a further filter were used for the search. Discussion The use of ketamine in PPC should be more widely considered due to its overall favourable safety profile and its efficacy, which are supported by an increasing number of studies, although in settings different from PPC and of mixed quality. Ketamine should be proposed according to a case-by-case evaluation and the specific diagnosis and the dosage and route of administration should be tailored to the specific needs of patients. Furthermore, there is evidence to suggest that ketamine is safe and efficacious in acute pain. These findings can prompt further research on the use of ketamine for the treatment of acute pain in PPC. Conclusion Ketamine could be a suitable option after the failure of conventional drugs in the treatment of different refractory conditions in PPC.

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“…Botulinum toxin treatment has most often been used in 4–6-year olds to reduce spasticity (Franzen, Hägglund & Alriksson-Schmidt 2017). Healthcare professionals should offer evidence-based intervention, such as BoNT, although it is necessary to carry out intervention in a comfortable way (Nilsson et al 2017).…”

Section: Additional Resources Perceived As Missingmentioning

confidence: 99%

How pain management for children with cerebral palsy in South African schools complies with up-to-date knowledge

2019

Self Cite

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BackgroundPain in children with cerebral palsy (CP) has its sources in musculoskeletal problems that can influence learning in a school setting. Best pain management is essential for these children, but school staff may not keep up to date with the latest developments and interventions. Therefore, staff’s perceptions of beneficial strategies may not comply with contemporary scientific knowledge about effective evidence-based interventions.ObjectivesThis study investigated how pain management intervention for children with CP in South African schools complied with international scientific knowledge about evidence-based interventions. The intention was to provide support for an update of knowledge on both individual level (i.e. professionals) and system level (i.e. decision makers).MethodFive focus groups were conducted with staff members at five schools for children with special educational needs in South Africa. Manifest and latent content analyses of professional statements identified interventions reported as beneficial and related them to higher and lower levels of intervention evidence as reported at the time of data collection.ResultsMost treatment strategies concerned motor functioning that fell within the framework of physiotherapists and occupational therapists. Access to orthopaedic expertise was limited, waiting times were long and medication for spasticity treatment was not offered.ConclusionA discrepancy between published evidence and clinical practice for pain management in children with CP in South African school settings was noted. Suggestions for improved early intervention to identify children’s hips at risk through surveillance programmes; and orthopaedic management are proposed to prevent deformities and unnecessary suffering in South African children with CP.

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A rectally administered combination of midazolam and ketamine was easy, effective and feasible for procedural pain in children with cerebral palsy

Abstract: Rectally administered midazolam and racemic ketamine provided effective pain relief for paediatric cerebral palsy outpatients receiving painful injections and was a viable alternative to inhalation analgesia.

Cited by 11 publications

References 27 publications

Management of pain in children and adolescents with cerebral palsy: a systematic review

Management of pain in children and adolescents with cerebral palsy: a systematic review

Refractory symptoms in paediatric palliative care: can ketamine help?

How pain management for children with cerebral palsy in South African schools complies with up-to-date knowledge

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