[Evaluation of analgesic protocol with nitrous oxide and EMLA cream during botulinum toxin injections in children]

Area of Science:

• Pediatric Anesthesiology
• Neurology
• Pain Management

Background:

• Botulinum toxin injections are used to treat focal spasticity in children.
• Pain management during these procedures is crucial for patient tolerance and cooperation.
• Existing analgesic methods require evaluation for efficacy and safety in pediatric populations.

Purpose of the Study:

• To assess the effectiveness and tolerability of combined nitrous oxide and topical eutectic mixture of local anesthetics (EMLA) for pain management.
• To evaluate this analgesic approach in pediatric patients undergoing botulinum toxin injections for spasticity.

Main Methods:

• A prospective study included 40 pediatric patients (ages 2-17) receiving botulinum toxin injections.
• Patients received topical EMLA and inhaled a mixture of 50% nitrous oxide and 50% oxygen.
• Patient reactions were systematically recorded by clinical staff to differentiate pain-related responses from general anxiety.

Main Results:

• 45% of patients experienced no pain manifestations.
• 30% exhibited pain-related reactions like crying and withdrawal.
• 25% showed nonspecific manifestations attributed to anxiety and discomfort; 3 patients reported mild side effects (hallucinations, euphoria).

Conclusions:

• The combination of nitrous oxide and topical EMLA demonstrated partial efficacy in managing pain during pediatric botulinum toxin injections.
• The current protocol was insufficient for approximately half of the patients, indicating a need for protocol modification.
• Accurate pain assessment in children with cognitive deficits is challenging, as observed behaviors can reflect both pain and general anxiety/stress.