Safe lumbar puncture under analgo-sedation in children with acute lymphoblastic leukemia

Safe lumbar puncture under analgo-sedation in children with acute lymphoblastic leukemia

Maurizi P; Russo I; Rizzo D; Chiaretti A; Coccia P; Attinà G; Ruggiero A; Riccardi R

International Journal Of Clinical Oncology

2014

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

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

Backlog