Sedation-analgesia protocol for the injection of botulinum toxin A in cerebral palsy

Objective: To evaluate the impact of the sedation-analgesia technique on the pain experienced by the patient. Methods: This cross-sectional study was conducted on consecutive patients with cerebral palsy (CP) who underwent infiltration with botulinum toxin A (BoTNA). The patients were divided into 4 different groups according to the analgesic strategy assigned: Group I, without sedation or topical anaesthetic cream; Group II, inhalation of nitrous oxide; Group III, deep intravenous sedation; and Group IV, light sedation with benzodiazepines. Pain was assessed with different scales depending on patient age. Parents were asked to rate their satisfaction with their child's comfort by using a 5-point Likert-type scale. The primary end-point was the proportion of patients that experienced a pain level equal or lower than 2, according to pain scales, in the different study groups. Results: Of the 124 patients included in the study, 56 (45.2%) experienced a pain level <= 2. In the Group III a significantly greater proportion of patients were classified with a pain level score <= 2, P< .001, as compared with all the study groups, respectively. The BoTNA injection was guided by ultrasonography in 109 (87.9%) patients, and by palpation in 15 (12.1%). Conclusion: The results of this study suggested that, in patients with CP treated with BoTNA injections, the sedation-analgesic strategy had a significant impact on the pain experienced by the subject. Selecting an appropriate analgesic strategy is crucial for reducing the stress associated with the administration of BoTNA injections in children with CP. (C) 2019 Published by Elsevier Espana, S.L.U. on behalf of Asociacion Espanola de pediatria.