Anaesthesia and pain management in cerebral palsy

Jf, Nolan; Chalkiadis, George; Low, J.; Olesch, Christine; Brown, T. C. K.

doi:10.1046/j.1365-2044.2000.01065.x

Cited by 151 publications

(111 citation statements)

References 39 publications

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“…Pain from a muscle spasm is severe and distressing for cerebral palsy patients with spasticity [15]. Drugs such as baclofen, diazepam, and other benzodiazepines that modulate central triggers of spasticity are usually administered orally.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, in cerebral palsy patients who often undergo lower limb orthopedic surgery (as in our patient's third surgery), epidural analgesia is recommended to prevent muscle spasm, which is a spinal reflex initiated by pain [15]. Thus, epidural analgesia can be an option to prevent the severe pain associated with muscle spasms in patients with Krabbe disease.…”

Section: Discussionmentioning

confidence: 99%

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Usefulness of dexmedetomidine to prevent emergence agitation in a patient with Krabbe disease: a case report

Saito

Kimura

Hashimoto³

et al. 2018

JA Clin Rep

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Background: We report the case of a child with Krabbe disease who underwent three repeated surgeries and anesthetic management, and we discuss the major concerns about Krabbe disease and the usefulness of a perioperative administration of dexmedetomidine to prevent emergence agitation and hypertension. The patient was scheduled to undergo bilateral orchiopexy, adenotonsillectomy, and knee flexor tendon lengthening under general anesthesia during a 2-year period. Case presentation: Adenotonsillectomy was scheduled as the second operation when the patient was 4 years old. His height and body weight were 93 cm and 10.3 kg, respectively. Anesthesia was induced with 8% sevoflurane mixed with 6 L/min of O 2 and maintained with N 2 O (3.5 L/min), O 2 (1.5 L/min), and sevoflurane (1.5-2.0%). Upon completion of the right tonsillectomy, 1 h before the end of the surgery, a continuous infusion of dexmedetomidine (0.2 μg/kg/h) was started to prevent emergence agitation, irritability, resultant hypertension, and postoperative bleeding. Fentanyl (25 μg) was administered intravenously to reduce postoperative pain. The surgery was uneventful, and the patient's emergence from general anesthesia was prompt. He exhibited no symptoms of emergence agitation or irritability. During his stay in the intensive care unit, 0.2-0.7 μg/kg/h of dexmedetomidine and 6.25 μg/h of fentanyl were continuously administered. The patient was discharged to the ward the following morning without complications. Conclusions: The perioperative administration of dexmedetomidine was useful to prevent emergence agitation, hypertension, and resultant postoperative bleeding in a pediatric patient with Krabbe disease. Three repeated anesthetic management using inhalation anesthesia were completed uneventfully without muscle relaxants.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Usefulness of dexmedetomidine to prevent emergence agitation in a patient with Krabbe disease: a case report

Saito

Kimura

Hashimoto³

et al. 2018

JA Clin Rep

View full text Add to dashboard Cite

show abstract

“…Supplementation with epidural clonidine or opioid is warranted to improve analgesia and reduce the likelihood of postoperative muscle spasm in children with spasticity. 17 Adding epidural fentanyl to bupivacaine resulted in better analgesia after unilateral femoral osteotomy in healthy children 18 but has been associated with oxygen desaturation and pruritis in children with CP. 5 Adding clonidine to epidural local anaesthetic has theoretical advantages.…”

Section: Discussionmentioning

confidence: 99%

Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery

Chalkiadis

Sommerfield

Low

et al. 2015

Develop Med Child Neuro

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AUCArea under the curve SEMLS Single-event multilevel surgery AIM To compare diazepam use, muscle spasm, analgesia, and side effects when clonidine or fentanyl are added to epidural bupivacaine in children with cerebral palsy after multilevel orthopaedic surgery.METHOD Fifty children were prospectively randomized to receive clonidine (n=24, mean age 10y 10mo [SD 2y 11mo]) or fentanyl (n=26, mean age 10y 11mo [SD 2y 10mo]).RESULTS There was no difference in primary outcome measures: median diazepam use (fentanyl 0, interquartile range [IQR] 0-0; clonidine 0, IQR 0-0; p=0.46), any muscle spasm (no muscle spasms in: fentanyl, 36%; clonidine, 62%; p=0.11), painful muscle spasm (fentanyl 40%; clonidine 25%; p=0.46), or pain score ≥6 (none: fentanyl 44%; clonidine 42%; p=0.29). There were differences in secondary outcome measures: no vomiting (clonidine 63%; fentanyl 20%); vomiting occurred more frequently with fentanyl (32% vomited more than three times; clonidine none; p=0.001). Fentanyl resulted in more oxygen desaturation (at least two episodes: fentanyl 20%; clonidine 0; p<0.001). Clonidine resulted in lower mean (SD) area under the curve for systolic blood pressure (fentanyl 106.5 [11.0]; clonidine 95.7mmHg [7.9]) and heart rate (fentanyl 104.9 beats per minute [13.6]; clonidine 85.3 [11.5]; p<0.001).INTERPRETATION Clonidine and fentanyl provide adequate analgesia with low rates of muscle spasm, resulting in low diazepam use. The choice of epidural additive should be based upon the most tolerable side-effect profile.Cerebral palsy (CP) by definition is a disorder of movement and posture, caused by a non-progressive brain injury or lesion. 1 However, although the causative brain lesion is defined as a static encephalopathy, the musculoskeletal pathology in the limbs is progressive during the child's growth and maturation, with the development of contractures, bony torsion, and joint instability. Children with CP may undergo extensive orthopaedic surgery of the lower extremities to correct deformity and improve function. Single-event multilevel surgery (SEMLS), defined as at least one surgical procedure, performed on two different anatomical levels (hip, knee, or ankles), has been shown to result in dramatic improvements in gait and functioning, which are sustained at 5-year follow-up and reduce the need for serial surgeries and periods of rehabilitation. 2,3 Good pain control is important for patient comfort and facilitates early rehabilitation and discharge. Effective pain management is challenging because of multiple surgical incisions, associated comorbidities (chronic lung disease, risk of aspiration, epilepsy, gastro-oesophageal reflux), and impairments in communication and/or cognition that may make pain assessment difficult. In addition, the surgical nociceptive input is likely to lead to wind-up of spinal reflexes and worsening of muscle spasm 4 and possibly to an escalating pain-spasm cycle. Epidural analgesia is the preferred modality of regional anaesthesia in our institution but there are limited data...

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“…Opioids, with or without benzodiazepine adjuvants, should be used for acute or procedural pain. Epidural analgesia is particularly valuable during orthopedic procedures, and postoperative pain can be treated with patient-controlled and regional analgesic techniques, and appropriate monitoring (26).…”

Section: Painmentioning

confidence: 99%

The child with multiple impairments

2000

Paediatrics &Amp; Child Health

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Anaesthesia and pain management in cerebral palsy

Cited by 151 publications

References 39 publications

Usefulness of dexmedetomidine to prevent emergence agitation in a patient with Krabbe disease: a case report

Usefulness of dexmedetomidine to prevent emergence agitation in a patient with Krabbe disease: a case report

Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single‐event multilevel surgery

The child with multiple impairments

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