Ingrid Rabach1, Francesca Peri2,3, Marta Minute1, Emanuela Aru4, Marianna Lucafò5, Alberto Di Mascio4, Giorgio Cozzi1, Egidio Barbi1,4. 1. Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Via dell'Istria 65/1, 34100, Trieste, Italy. 2. Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Via dell'Istria 65/1, 34100, Trieste, Italy. francescaperi92@gmail.com. 3. University of Trieste, Trieste, Italy. francescaperi92@gmail.com. 4. University of Trieste, Trieste, Italy. 5. Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
Abstract
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.
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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