Pain management during bone marrow aspiration and biopsy in pediatric cancer patients

Abstract

Significant issues were identified regarding the efficacy and safety of pain management. Adverse events can occur in any institution. Children with underlying or complicated conditions are at high risk for serious adverse events. Therefore, adequate and systematic assessment, patient monitoring, preparation and treatment for adverse events, and cooperation with skilled specialists of pediatric oncology, anesthesiology, and intensive care are essential.

Complications of Deep Sedation for Individual Procedures (Lumbar Puncture Alone) Versus Combined Procedures (Lumbar Puncture and Bone Marrow Aspirate) in Pediatric Oncology Patients

“…These patients are at a reportedly higher risk for sedation-related events. 4,5 No evidence-based protocols or exact drug regimens exist for procedures in such patients. The goal of procedural sedation in these patients is to reduce anxiety, discomfort, and pain while providing optimal conditions for the procedure with minimal AEs.…”

“…3 In general, children are at a greater risk for sedation-related adverse events (AEs) than adults, especially children with underlying conditions, such as leukemia and other oncologic diseases. 4,5 Little is known about the complication rates for performing these procedures individually (LP alone) versus combining (LP and BMA) them into a single sedation encounter. Sedation safety and success are maximized when evidencebased protocols are in place for uniformity of care, but no such standardized practices exist for sedation encounters in pediatric oncology patients.…”

General anesthesia, conscious sedation, or nothing: Decision‐making by children during painful procedures

“…The existing literature examines pharmacological versus nonpharmacological support and sedation versus no sedation, and describes different ways to prepare children for these procedures . However, none of these studies included asking children directly about their preferences for the type of medical support.…”

“…We understood that the fear of the procedure was not neutralized by GA for some patients and that GA itself was a source of additional anxiety and discomfort, potentially due to its symbolic association with death. [30][31][32][33][34] The existing literature examines pharmacological versus nonpharmacological support [35][36][37][38][39][40] and sedation versus no sedation, 30,[41][42][43][44][45][46][47][48][49][50] and describes different ways to prepare children for these procedures. 11,51,52 However, none of these studies included asking children directly about their preferences for the type of medical support.…”

La kétamine : une alternative à l’anesthésie générale pour les gestes douloureux en cancérologie pédiatrique – sécurité, efficacité et faisabilité –

“…Ce médicament y est décrit comme pouvant être utilisé en monothérapie, par des médecins entraînés tels que les urgentistes ou réani-mateurs pédiatriques dans un environnement hospitalier de qualité pour un niveau de sécurité optimal. Sur le plan international, on ne retrouve pas de consensus et la prise en charge au sein d'un même pays est également variable [7][8][9].…”