Safe lumbar puncture under analgo-sedation in children with acute lymphoblastic leukemia
adolescent; Child; Female; Humans; infant; Male; Pain; Pain Measurement; Deep Sedation; Propofol; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Central Nervous System; Preschool; Injections; Spinal; Spinal Puncture
BACKGROUND: Children with acute lymphoblastic leukemia (ALL) undergo multiple lumbar punctures (LPs) during their course of treatment for diagnostic and therapeutic purposes. LP is a stressful and painful procedure, affecting the quality of life of these children. Procedural analgo-sedation might improve the child's comfort and prevent the child's movements, reducing the risk of traumatic lumbar puncture with blasts (TLP+), mainly at diagnosis, when higher numbers of blast cells are circulating in the peripheral blood. The aim of this study was to evaluate the safety and efficacy of procedural analgo-sedation in children with ALL. METHODS: From September 2006 to November 2008, we performed a total of 252 lumbar punctures under deep sedation with propofol and ketamine in 25 children with ALL treated at our division. During the procedures, vital parameters were monitored and side effects were recorded. The efficacy of deep sedation was evaluated using Ramsay and Children's Hospital Eastern Ontario Pain scales. Cerebrospinal fluid was collected for chemical and cytological examinations. RESULTS: In all patients a satisfactory sedation and analgesia were achieved. The evaluation of vital parameters did not show any significant variation compared to baseline values. No side effects were recorded. Only 3 (1.2 %) of 252 lumbar punctures resulted in traumatic effects. CONCLUSION: To strongly improve comfort and quality of life of children with ALL and reduce the risk of TLP+ mainly at diagnosis, we recommend performing the lumbar punctures under analgo-sedation because it is a safe and effective procedure.
2014-02
Maurizi P; Russo I; Rizzo D; Chiaretti A; Coccia P; Attinà G; Ruggiero A; Riccardi R
International Journal Of Clinical Oncology
2014
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1007/s10147-013-0521-1" target="_blank" rel="noreferrer">10.1007/s10147-013-0521-1</a>
The use of an intrathecal pump to manage intractable cancer pain in a pediatric patient: a case report
adolescent; Female; Humans; Pain; Pain Measurement; Analgesics; Prognosis; Fatal Outcome; Infusion Pumps; Injections; Spinal; Implantable; Carcinoma; Intractable; Anus Neoplasms; Condylomata Acuminata; Immunologic Deficiency Syndromes; Neutropenia; Squamous Cell; Vulvar Diseases
A 15-year-old girl with combined immune deficiency syndrome, diagnosed with metastatic squamous cell cancer of the anus, had significant pain secondary to vulvar-perianal condyloma. Conventional treatment with oral and intravenous analgesics was limited by significant side effects of mental status changes and urinary retention leading to clinical deterioration that precluded attempts at chemotherapy. An intrathecal pump was implanted in the challenging setting of neutropenia. There was a drastic improvement in her quality of life and the ability to tolerate further chemotherapy. The option of an intrathecal pump for pain control extended our patient's ability to enjoy important quality time with family by several months.
2014-04
Bengali R; Huang MS; Gulur P
Journal Of Pediatric Hematology/oncology
2014
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/MPH.0b013e31828e5dca" target="_blank" rel="noreferrer">10.1097/MPH.0b013e31828e5dca</a>
Nociceptin levels in the cerebrospinal fluid of chronic pain patients with or without intrathecal administration of morphine
Female; Humans; Male; Analgesics; Aged; Middle Aged; Chronic disease; Injections; Opioid/administration & dosage; Spinal; Biological Markers/cerebrospinal fluid; Morphine/administration & dosage; Opioid Peptides/cerebrospinal fluid; Pain Measurement/drug effects/methods; Pain/cerebrospinal fluid/diagnosis/drug therapy
The neuropeptide nociceptin/orphanin FQ (N/OFQ) is the endogenous ligand for the opioid-like receptor ORL-1 and is thought to be involved in pain transmission and modulation. Human studies have not yet defined its role in pain patients. The aims of this study were 1) to verify the presence of N/OFQ in the cerebrospinal fluid (CSF) of human controls and patients with chronic noncancer pain, including those treated with intrathecally administered morphine, and 2) to determine whether pain or treatment with long-term intrathecal morphine influences its levels. The CSF of 27 patients (nine controls and 18 with chronic noncancer pain, of whom 12 were treated chronically with intrathecally administered morphine and six were opioid naive) was analyzed, blindly, with radioimmunoassay methods. N/OFQ was detected in all patients. Mean CSF concentrations were lowest in the morphine-treated group and highest in the untreated chronic pain patients (12.06+/-1.19 and 57.41+/-10.06 fmol/ml, respectively), and the difference between the morphine-treated group and controls was statistically significant (44.72+/-13.56 fmol/ml, P<0.05). The presence of N/OFQ peptide in human CSF may correlate with biological activities that are influenced by different pain states and long-term intrathecal-morphine treatment. Further studies should verify whether the determination of this peptide CSF level may provide information on opioid treatment efficacy and on the presence of opioid tolerance.
2006
Raffaeli W; Samolsky DBG; Landuzzi D; Caminiti A; Righetti D; Balestri M; Montanari F; Romualdi P; Candeletti S
Journal Of Pain And Symptom Management
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.jpainsymman.2006.05.013" target="_blank" rel="noreferrer">10.1016/j.jpainsymman.2006.05.013</a>
Modulation of peripheral endogenous opioid analgesia by central afferent blockade
Male; Analgesics; Animals; Rats; Injections; Immunohistochemistry; Spinal; Enkephalin; beta-Endorphin/metabolism; Wistar; Pain Threshold/drug effects; Neurons; Afferent/drug effects; Central Nervous System/drug effects; Endorphins/metabolism/physiology; Flow Cytometry; Foot/pathology; Inflammation/pathology; Methionine/metabolism; Morphine/administration & dosage/pharmacology; Opioid/administration & dosage/pharmacology; Peripheral Nerves/drug effects; Psychomotor Performance/drug effects
BACKGROUND: Peripheral tissue injury causes a migration of opioid peptide-containing immune cells to the inflamed site. The subsequent release and action of these peptides on opioid receptors localized on peripheral sensory nerve terminals causes endogenous analgesia. The spinal application of opioid drugs blocks the transmission of nociceptive information from peripheral injury. This study investigates the influence of exogenous spinal opioid analgesia on peripheral endogenous opioid analgesia. METHODS: Six and forty-eight hours after initiation of continuous intrathecal morphine infusion and administration of Freund's complete adjuvant into the hind paw of rats, antinociceptive and antiinflammatory effects were measured by paw pressure threshold, paw volume, and paw temperature, respectively. Inflammation and quantity of opioid-containing cells were evaluated by immunocytochemistry and flow cytometry. Cold water swim stress-induced endogenous analgesia was examined 24 h after discontinuation of intrathecal morphine administration. RESULTS: Intrathecal morphine (10 micro g/h) resulted in a significant and stable increase of paw pressure threshold ( P 0.05). At 48 but not at 6 h after Freund's complete adjuvant, the number of beta-endorphin-containing cells and cold water swim-induced antinociception were significantly reduced in intrathecal morphine-treated rats compared with those treated with intrathecal vehicle ( P< 0.05). CONCLUSIONS: These findings suggest an interplay of central and peripheral mechanisms of pain control. An effective central inhibition of pain apparently signals a reduced need for recruitment of opioid-containing immune cells to injured sites.
2003
Schmitt TK; Mousa SA; Brack A; Schmidt DK; Rittner HL; Welte M; Schafer M; Stein C
Anesthesiology
2003
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/00000542-200301000-00030" target="_blank" rel="noreferrer">10.1097/00000542-200301000-00030</a>
Morphine and alternative opioids in cancer pain: the EAPC recommendations
Humans; Analgesics; Drug Administration Schedule; Administration; Oral; Palliative Care/standards; Injections; Intravenous; Subcutaneous; Oxycodone/administration & Pain/drug therapy; Opioid/administration & dosage/adverse effects/therapeutic use; Spinal; Chemistry; Fentanyl/administration & dosage/therapeutic use; Hydromorphone/administration & Infusions; Methadone/pharmacokinetics/therapeutic use; Morphine/administration & Neoplasms/drug therapy; Pharmaceutical
An expert working group of the European Association for Palliative Care has revised and updated its guidelines on the use of morphine in the management of cancer pain. The revised recommendations presented here give guidance on the use of morphine and the alternative strong opioid analgesics which have been introduced in many parts of the world in recent years. Practical strategies for dealing with difficult situations are described presenting a consensus view where supporting evidence is lacking. The strength of the evidence on which each recommendation is based is indicated.
2001
Hanks GW; Conno F; Cherny NI; Hanna M; Kalso E; McQuay HJ; Mercadante S; Meynadier J; Poulain P; Ripamonti C; Radbruch L; Casas JR; Sawe J; Twycross RG; Ventafridda V; Expert Working Group of the Research Network of the European Association for Palliative Care
British Journal Of Cancer
2001
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1054/bjoc.2001.1680" target="_blank" rel="noreferrer">10.1054/bjoc.2001.1680</a>