The management of procedural pain at the Italian Centers of Pediatric Hematology–Oncology: state-of-the-art and future directions

Po, Chiara; Benini, Franca; Sainati, Laura; Farina, Maria Immacolata; Cesaro, Simone; Agosto, Caterina

doi:10.1007/s00520-011-1347-x

Cited by 10 publications

(12 citation statements)

References 33 publications

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“…Sedation is usually performed in the operating room by pediatric anesthetists or medical professionals such as qualified pediatric advanced life support specialists. Guidelines have been developed and effective sedatives and analgesics, including some opioids and inhalation anesthetics, are recommended for use in the appropriate setting . In contrast, in Japan, pediatric cancer patients are treated in various facilities, as was seen in the present study.…”

Section: Discussionmentioning

confidence: 89%

“…The aim of pain management is to achieve maximum safety and efficacy with a minimum of adverse events. Some guidelines or standards have already been developed in Western countries . Adequate and thorough medical assessment, monitoring, and preparation of, adequate sedation and analgesia are provided as a part of regular health care in these countries.…”

Section: Discussionmentioning

confidence: 99%

“…The importance of non‐pharmacological professional approaches to pain has been emphasized in studies based in Western countries. To improve the safety and efficacy of procedural pain management in patients requiring BMAB, some guidelines have been established by WHO and Western countries, including the USA, Scotland, Australia and Italy . In these guidelines, adequate sedation and analgesia are recommended as part of strict systemic management, but no specific references are made to sedation and analgesia in the clinical guidelines for cancer pain management developed by the Japanese Society for Palliative Medicine, or the guidelines for palliative care of pediatric cancer patients developed by the Children's Cancer Association of Japan .…”

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confidence: 99%

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

Kato

Maeda

Aoki

et al. 2014

Pediatrics International

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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.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Kato

Maeda

Aoki

et al. 2014

Pediatrics International

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“…However, these recommendations are frequently overlooked and procedural pain is often not treated adequately [ 4 ]. In specific clinical fields, such as paediatrics, the need to improve prevention and treatment of procedural pain has recently encouraged research in this care problem [ 5 , 6 ]. For digestive endoscopy, there are guidelines written by the major scientific societies which recommend the gold standards, the best procedures and the necessary training for medical professionals [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

A phase II study on the efficacy and safety of procedural analgesia with fentanyl buccal tablet in cancer patients for the placement of indwelling central venous access systems

Bortolussi

Zotti

Matovic

et al. 2015

Support Care Cancer

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BackgroundPain in cancer patients is often related to oncologic therapies and diagnostic procedures. The placement of fully implantable venous access systems is a very common procedure in oncology patients. Local anaesthesia is the method most commonly used to overcome pain related to this surgical procedure, but the local anaesthetic may be unable to completely eradicate all pain. This study investigates the effectiveness and safety of fentanyl buccal tablet (FBT), administered by OraVescent® technology, in reducing procedural pain related to the placement of indwelling central venous access systems (Ports) in opioid-naïve cancer patients.MethodsInpatients who required an indwelling vascular access (Port) were preoperatively assessed with a self-assessment questionnaire on anxiety and pain. A 100 μg FBT was administered 10 min before preparation of the operating field. A self-assessment scale for pain experienced during the procedure was administered at the end of the procedure. Vital signs and the presence of any side effects or bothersome symptoms were monitored during the procedure, at the end, and 4 h later.ResultsFrom October 2012 to June 2014, 65 patients were enrolled in the study. A total of 61 (93.9 %) patients perceived no or a little pain during the procedure. Four patients (6.2 %) reported a lot of pain. No patient reported very severe pain. This data is significant in terms of the lower than expected presence of pain (Fisher test p = 0.0018) as assessed in our previous experience without procedural analgesia. The most common side effects of FBT was drowsiness, experienced by 28 patients at the end of the procedure (43.1 %), significantly reduced (p < 0.01) to 8 patients after 4 h (12.5 %). Nausea was present in 6 cases at the end of the procedure (9.2 %) and in 7 cases 4 h later (10.9 %). Vomiting was present in 3 cases at the end (4.7 %) and in 2 other patients after 4 h (7.8 %). No significant change of vital parameters was observed between the baseline and the subsequent measurements in all patients studied.ConclusionsThe significant improvement in the number of patients experiencing little or no pain, accompanied by a lower number of non-severe side effects, suggests that FBT is a valid, practical and safe method of procedural analgesia. It will be necessary to perform further studies, taking into account the need for standard antiemetic pre-medication to minimise the incidence of nausea and vomiting.

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“…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.…”

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confidence: 99%

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

Maslak

Favara-Scacco

Barchitta

et al. 2019

Pediatric Blood & Cancer

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Background Following diagnosis, children with cancer suddenly find themselves in an unknown world where unfamiliar adults make all the important decisions. Children typically experience increasing levels of anxiety with repeated invasive procedures and do not adapt to the discomfort. The aim of the present study is to explore the possibility of asking children directly about their medical support preferences during invasive procedures. Procedure Each patient was offered a choice of medical support on the day of the procedure, specifically general anesthesia (GA), conscious sedation (CS), or nothing. An ad hoc assessment tool was prepared in order to measure child discomfort before, during, and after each procedure, and caregiver adequacy was measured. Both instruments were completed at each procedure by the attending psychologist. Results We monitored 247 consecutive invasive procedures in 85 children and found that children in the 4 to 7 year age group showed significantly higher distress levels. GA was chosen 66 times (26.7%), CS was chosen 97 times (39.3%), and nothing was chosen 5 times and exclusively by adolescents. The child did not choose in 79 procedures (32%). The selection of medical support differed between age groups and distress level was reduced at succeeding procedures. Conclusions Offering children the choice of medical support during invasive procedures allows for tailored support based on individual needs and is an effective modality to return active control to young patients, limiting the emotional trauma of cancer and treatment.

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The management of procedural pain at the Italian Centers of Pediatric Hematology–Oncology: state-of-the-art and future directions

Cited by 10 publications

References 33 publications

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

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

A phase II study on the efficacy and safety of procedural analgesia with fentanyl buccal tablet in cancer patients for the placement of indwelling central venous access systems

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

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