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Sedation and analgesia in children with cerebral palsy: a narrative review
Ingrid Rabach1, Francesca Peri2,3, Marta Minute1
1Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Via dell'Istria 65/1, 34100, Trieste, Italy.
Insights
Children with cerebral palsy (CP) experience significant pain and require procedural sedation. Current pain management strategies are limited by a lack of anxiety scales and inconsistent non-pharmacological technique results, necessitating further research.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Cerebral Palsy Research
Background:
- Children with cerebral palsy (CP) experience pain more frequently than healthy children.
- Painful procedures are common in children with CP, requiring analgesia and procedural sedation.
- Inadequate pain recognition and perceived risks complicate sedation management in this population.
Purpose of the Study:
- To review literature on pain and sedation in children with cerebral palsy (CP).
- To identify specific risk factors and areas for improvement in pain management and sedation.
- To highlight the need for better strategies for children with CP.
Main Methods:
- Literature search of Cochrane Library, Medline, and Pubmed (1987-2018).
- Keywords included 'cerebral palsy and children and pain' and 'sedation and cerebral palsy and children'.
- Focused on risk factors and areas needing improvement.
Main Results:
- Existing pain scales aid recognition, but anxiety scales are unavailable.
- Non-pharmacological pain management techniques show variable results.
- Anatomical and physiological factors (liver/kidney function) are critical considerations for sedation.
Conclusions:
- Further large-scale trials are necessary.
- Evaluate the efficacy of non-pharmacological pain interventions.
- Determine optimal pharmacological and non-pharmacological pain control strategies for diverse clinical settings.
Background:
Patients with cognitive impairment due to cerebral palsy experience pain more often than healthy peers and frequently require diagnostic and therapeutic painful procedures. Analgesia and procedural sedation outside the operating room are often required, but they may not adequately be provided because of the inability to accurately recognize and classify the state of pain and for the perceived higher risk of complications.
Data Sources:
We reviewed the available literature to highlight the specific risk factors and area of criticism, that should be further improved. We searched the Cochrane Library, Medline, Pubmed from 1987 to September 2018 using key words such as 'cerebral palsy and children and pain' or 'sedation and cerebral palsy and children'.
Results:
While different pain scales are useful in recognizing pain expressions, anxiety scales are not available. Moreover, studies on non-pharmacological techniques do not always have comparable results. Several risk factors, from anatomic abnormalities to liver and kidney functioning, should be kept in mind before proceeding with sedation.
Conclusions:
Large trials are needed to assess the impact of non-pharmacological techniques and to evaluate which pain control strategy (pharmacological and non-pharmacological) should be used in different settings.
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