psd-502 and Cerebral-Palsy

To evaluate the efficiency and tolerance of analgesic treatment with nitrous oxide and topical eutectic mixture of local anesthetics (EMLA) in children undergoing botulinum toxin injections for focal spasticity.. Prospective study including 40 consecutive patients aged 2 to 17 years, most with cerebral palsy, undergoing botulinum toxin injections. Ten had severe cerebral palsy with cognitive deficiency. For most patients the treatment involved several muscles, with several injections per muscle. The total number of injections varied from 1 to 25. The procedure was performed with topical anesthesia with EMLA and inhalation of nitrous oxide (50% nitrous oxide, 50% oxygen). Reactions were recorded by the staff (a practician, a nurse, an auxiliary staff member and an internist) and whether they related to the injection or were nonspecific.. A total of 45% of patients showed no clinical manifestation of pain; for 30%, reactions were crying and withdrawal directly related to the injections; and for 25%, manifestations seemed nonspecific and mainly related to overall anxiety and discomfort. In 3 patients, moderate side effects were observed (visual hallucinations and euphoria).. Nitrous oxide analgesic with topical EMLA was efficient for children undergoing botulinum toxin injections but remained insufficient for half of our patients, and modification of the protocol is needed in some cases. Precise evaluation of acute pain is difficult in children with major cognitive deficits. Clinical manifestations are related to pain but also to overall anxiety and stress.

Topics: Adolescent; Analgesics, Non-Narcotic; Anesthetics, Local; Botulinum Toxins, Type A; Cerebral Palsy; Child; Child, Preschool; Female; Humans; Injections, Intramuscular; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Neuromuscular Agents; Nitrous Oxide; Ointments; Pain; Prilocaine; Prospective Studies

To evaluate the effectiveness of an analgesic protocol with nitrous oxide and anaesthetic cream (lidocaine and prilocaine, EMLA) for children undergoing botulinum toxin injections.. Prospective study including 51 injection sessions, 34 children with a mean age of 5.94 (range 2-15) and 209 injected muscles. Pain was evaluated with the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), the Visual Analogue Scale (VAS) and the Face Pain Scale (FPS) for the children and with a VAS for the parents.. CHEOPS score for the 51 sessions was 8.50 (S.D. 3.56). Forty-nine percent of scores were above the therapeutic threshold of 9; 25% of the children evaluated the pain above the therapeutic threshold of 3; 44.74% of the parents' estimations exceeded 3. No correlation was found between age, weight, number of injected muscle and CHEOPS score.. The association of MEOPA and anaesthetic cream is only effective for 50% of children. This is much lower than treatments for other types of acute induced pain in children. Botulinum toxin injections and cerebral palsy children present certain specificities which require improvements in this analgesic protocol.

Topics: Administration, Cutaneous; Administration, Inhalation; Adolescent; Anesthetics; Anti-Dyskinesia Agents; Botulinum Toxins; Cerebral Palsy; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Injections, Intramuscular; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Nitrous Oxide; Oxygen Inhalation Therapy; Pain; Pain Measurement; Prilocaine; Prospective Studies; Risk Factors; Statistics, Nonparametric; Treatment Outcome