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Procedural Pain Management in Patients with Cerebral Palsy Undergoing Botulinum Toxin Injection: A Systematic Review
Silvia Faccioli1, Alessandro Ehsani2, Shaniko Kaleci3
1Pediatric Rehabilitation Unit, Azienda Unità Sanitaria Locale IRCCS of Reggio Emilia, 42122 Reggio Emilia, Italy.
Toxins
|July 25, 2025
Summary
Sedation and analgesia techniques effectively manage pain during botulinum injections for cerebral palsy (CP) patients. While generally safe, deep sedation offers superior pain control but necessitates an anesthetist for optimal patient care.
Area of Science:
- Medical Sciences
- Anesthesiology
- Pediatric Neurology
Background:
- Botulinum injections are common for managing spasticity in cerebral palsy (CP).
- Pain and anxiety during these procedures can be significant challenges.
- Effective pain management is crucial for patient comfort and adherence to treatment.
Purpose of the Study:
- To systematically review the effectiveness and safety of sedation-analgesia techniques for pain control during botulinum injections in CP patients.
- To synthesize evidence on various pharmacological and non-pharmacological pain management strategies.
- To assess the incidence and types of side effects associated with these techniques.
Main Methods:
- Systematic literature search of Pubmed, Cinahl, and Scopus databases.
- Inclusion of studies on cerebral palsy, pain, and side effects assessment in any study type and English language.
- Risk of bias assessment using RoB2 and Robins-I, with findings synthesized in tables and forest plots.
Main Results:
- Seventeen reports were included, focusing on pain control and side effects.
- Techniques ranged from non-pharmacological (virtual reality) to topical anesthesia (Emla, ice) and various sedation agents (nitrous oxide, midazolam, ketamine, propofol).
- Vomiting and oxygen desaturation were rare; pooled minor side effects occurred in 6.39% with significant heterogeneity.
Conclusions:
- All reviewed sedation-analgesia techniques are safe when administered in appropriate settings.
- Deep sedation provides superior pain control but requires anesthesiologist supervision.
- An individualized, combined approach to sedation and analgesia is recommended for optimal outcomes in CP patients.
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