Stefan Nilsson1, Ingemar Brunsson1, Berit Askljung1, Magnus Pahlman1, Kate Himmelmann1
1) Sweden
Aim: The aim of this study was to investigate how effective a combination of rectally administered midazolam and racemic ketamine was for reducing pain in paediatric cerebral palsy patients receiving intramuscular injections of botulinum neurotoxin A. The feasibility and safety of the pain relief were also explored.
Method: Children with cerebral palsy, aged 1-18 years, were recruited from a regional paediatric rehabilitation unit between April 2012 and May 2014. Pain intensity, feasibility, total time spent in the clinic and side effects were registered. Pain scores were recorded by parents and healthcare professionals using different pain scales.
Results: We recorded 128 procedures in 61 children. The median scores were two (range 0-10) for pain intensity and nine (range 0-10) for feasibility. The median treatment time in the outpatient unit was 3.25 hours and the most common side effects were nausea, pain and sleep disturbance. Gross motor function levels showed a negative correlation with the pain scores. This method could be an alternative to nitrous oxide/oxygen mixture for patients who do not tolerate inhalation analgesia.
Conclusion: Rectally administered midazolam and racemic ketamine provided effective pain relief for paediatric cerebral palsy outpatients receiving painful injections and was a viable alternative to inhalation analgesia.
