title: Do children undergoing cancer procedures under pharmacological sedation still report pain and anxiety? A preliminary study.
abstract: OBJECTIVE
  We aimed to quantify children's levels of pain and fear during needle puncture procedures in a context where intravenous sedation-analgesia seems to be effective for pain and anxiety relief. The relevance of a nonpharmacological intervention in the pharmacological regimen was evaluated.
  
  
  METHODS
  Fear and pain were assessed by children, parents and physicians, on a visual analog scale (VAS, 0-10 cm), before and during puncture procedures. Higher scores represented more intense pain/fear.
  
  
  RESULTS
  During 4 consecutive months, 18 children were recruited, but four were excluded from analyses because they did not receive the full sedation regimen (midazolam/ketamine) (N = 14, mean age +/- SD: 9.9 +/- 3.4 years). Parents self-reported their own anxiety before the procedure (4.69 +/- 3.17), but no correlation was found with their children's self-reported fear. Before procedures, the children's fear was self-reported on a VAS by children (2.93 +/- 2.93), parents (4.45 +/- 2.87), and physicians (3.67 +/- 2.48). During procedures under sedation, the children's pain (1.71 +/- 2.74) did not correlate with the parents' (4.01 +/- 3.23) and physicians' (1.83 +/- 2.32) ratings. Children anticipating high levels of pain and fear on the VAS experienced higher levels of pain (r = 0.65, P < 0.05) and fear (r = 0.59, P < 0.05) during the procedures. Sixteen parents (16/18) agreed to participate with their children if a study evaluating hypnosis for pain and anxiety was conducted.
  
  
  CONCLUSIONS
  Sedation is effective in lowering levels of fear and pain in children during procedures, but they still anticipate fear before the procedures. Parents are anxious for their children. Future hypnotic intervention could be helpful for children as well as parents to cope with anxiety during procedures.
authors.affiliation: Department of Pediatrics, Universite Laval, Quebec, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Dufresne
authors.forename: Marc-André
authors.initials: MA
authors.lastname: Dugas
authors.forename: Yvan
authors.initials: Y
authors.lastname: Samson
authors.forename: Patrick
authors.initials: P
authors.lastname: Barré
authors.forename: Lucile
authors.initials: L
authors.lastname: Turcot
authors.forename: Isabelle
authors.initials: I
authors.lastname: Marc
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D001007:Anxiety / Q000517:prevention & control* / Q000523:psychology; D001707:Biopsy, Needle; D001856:Bone Marrow Examination; D002648:Child; D002652:Child Behavior; D005190:Family; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D009339:Needles; D009369:Neoplasms; D010146:Pain / Q000517:prevention & control* / Q000523:psychology; D010147:Pain Measurement; D013129:Spinal Puncture
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives