Douleurs réfractaires de l'enfant cancéreux: place de l'analgésie péridurale

Portas, Mercedes; Marty, Julien; Buttin, C.; Gentet, J.C.; Coze, C.; Fallouh, Khalouk; Bernard, J; Camboulives, J

doi:10.1016/s0929-693x(98)80125-5

Cited by 13 publications

(1 citation statement)

References 61 publications

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“…Si le taux de succès de l'analgésie intrathécale est estimé entre 65 et 95% selon les séries d'adultes [5], il est difficile à évaluer chez l'enfant du fait du manque de données [6]. Le choix des molécules utilisées dépend du type de douleur et du contexte, néanmoins il parait raisonnable de ne pas utiliser d'emblée la bupivacaine en IT du fait des risques d'effets secondaires, et de la réserver aux cas de mauvaise efficacité des opioïdes et/ou des associations opioïdes/clonidine [7]. Il parait licite de limiter les indications de pompes implantables aux cas ou l'espérance de vie est supérieure à 2 mois.…”

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Douleurs chroniques et anesthésie locorégionale chez l’enfant

Dadure¹,

Marec²,

Veyckemans³

et al. 2013

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Chronic pain is usually underestimated in children, due to lack of knowledge and its specific signs. In addition to suffering, chronic pain causes a physical, psychological, emotional, social, and financial burden for the child and his family. Practitioners may find themselves in a situation of failure with depletion of medical resources. Some types of chronic pain are refractory to conventional systemic treatment and may require the use of regional anesthesia. Cancer pain is common in children and its medical management is sometimes insufficient. It is accessible to neuroaxial or peripheral techniques of regional anesthesia if it is limited to an area accessible to one of these techniques and no contraindications (e.g., thrombopenia) are present. Complex regional pain syndrome 1 is not rare in children and adolescents, but it often goes undiagnosed. Regional anesthesia may contribute to the treatment of complex regional pain syndrome 1, mainly in case of recurrence, because it provides rapid effective analgesia and allows rapid implementation of intensive physiotherapy. These techniques have also shown interest in phantom limb pain after limb amputation, but they remain controversial for erythromelalgia pain or chronic abdominopelvic pain. Finally, the treatment of postdural puncture headache due to cerebrospinal fluid leak can be treated by performing an epidural injection of the patient's blood, called a blood-patch. Finally, the management of children with chronic pain should be multidisciplinary (pediatrician, physiotherapist, psychologist, surgeon, anesthesiologist) to support the child and her problem in its entirety.

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Douleurs chroniques et anesthésie locorégionale chez l’enfant

Dadure¹,

Marec²,

Veyckemans³

et al. 2013

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Palliative Surgery for Pediatric Cancer Patients

Inserra

Shalkow

Martucci

2022

Pediatric Surgical Oncology

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Pediatric Oncology: Managing Pain at the End of Life

et al. 2016

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Pain is a common and highly distressing symptom in pediatric patients with advanced malignancies. Prompt recognition, assessment, and treatment of pain are necessary, especially at the end of life. Opioid medications remain the mainstay of treatment of malignant pain in children at the end of life and the amount of opioids required for adequate pain control in patients is highly variable. Nonpharmacological approaches including behavioral and physical approaches in addition to non-opioid pain medications should be used when possible to augment pain control. Identification and treatment of any underlying pathology is important and use of adjuvant medications based on pathophysiology and source of pain should be considered. In cases where adequate pain control is not achieved through these multiple modalities, an interdisciplinary approach including potential interventional techniques and alternative treatments is required. This multimodal approach to pain management is best provided by interdisciplinary teams, as these teams can best address the complex causes of pain and associated distress that occurs in patients and within families.

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Douleurs réfractaires de l'enfant cancéreux: place de l'analgésie péridurale

Cited by 13 publications

References 61 publications

Douleurs chroniques et anesthésie locorégionale chez l’enfant

Douleurs chroniques et anesthésie locorégionale chez l’enfant

Palliative Surgery for Pediatric Cancer Patients

Pediatric Oncology: Managing Pain at the End of Life

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