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Sedation and analgesia in children with cerebral palsy: a narrative review

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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.

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Funding

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

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Authors and Affiliations

  1. Institute for Maternal and Child Health, IRCCS ‘Burlo Garofolo’, Via dell’Istria 65/1, 34100, Trieste, Italy

    Ingrid Rabach, Francesca Peri, Marta Minute, Giorgio Cozzi & Egidio Barbi

  2. University of Trieste, Trieste, Italy

    Francesca Peri, Emanuela Aru, Alberto Di Mascio & Egidio Barbi

  3. Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy

    Marianna Lucafò

Authors
  1. Ingrid Rabach
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  2. Francesca Peri
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  3. Marta Minute
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  4. Emanuela Aru
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  5. Marianna Lucafò
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  6. Alberto Di Mascio
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  7. Giorgio Cozzi
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  8. Egidio Barbi
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Contributions

IR, FP, MM, ML, and GC had primary responsibility for writing the manuscript. EA and AM were responsible for the literature review about children sedation during specific procedures. EB has supervised and contributed to the writing of the manuscript. Funding: No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

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Correspondence to Francesca Peri.

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Rabach, I., Peri, F., Minute, M. et al. Sedation and analgesia in children with cerebral palsy: a narrative review. World J Pediatr 15, 432–440 (2019). https://doi.org/10.1007/s12519-019-00264-0

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