Effectiveness of nitrous oxide and analgesic cream (lidocaine and prilocaine) for prevention of pain during intramuscular botulinum toxin injections in children.
OBJECTIVE
To evaluate the effectiveness of an analgesic protocol with nitrous oxide and anaesthetic cream (lidocaine and prilocaine, EMLA) for children undergoing botulinum toxin injections.


METHODS
Prospective study including 51 injection sessions, 34 children with a mean age of 5.94 (range 2-15) and 209 injected muscles. Pain was evaluated with the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), the Visual Analogue Scale (VAS) and the Face Pain Scale (FPS) for the children and with a VAS for the parents.


RESULTS
CHEOPS score for the 51 sessions was 8.50 (S.D. 3.56). Forty-nine percent of scores were above the therapeutic threshold of 9; 25% of the children evaluated the pain above the therapeutic threshold of 3; 44.74% of the parents' estimations exceeded 3. No correlation was found between age, weight, number of injected muscle and CHEOPS score.


CONCLUSIONS
The association of MEOPA and anaesthetic cream is only effective for 50% of children. This is much lower than treatments for other types of acute induced pain in children. Botulinum toxin injections and cerebral palsy children present certain specificities which require improvements in this analgesic protocol.
Brochard
S
S
Service de médecine physique et de réadaptation, centre hospitalo-universitaire Morvan, 5, avenue Foch, 29200 Brest, France. sylvain.brochard@chu-brest.fr
Blajan
V
V
Lempereur
M
M
Le Moine
P
P
Peudenier
S
S
Lefranc
J
J
Rémy-Néris
O
O
D000279:Administration, Cutaneous; D000280:Administration, Inhalation; D000293:Adolescent; D000777:Anesthetics / Q000627:therapeutic use*; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage; D001905:Botulinum Toxins / Q000008:administration & dosage; D002547:Cerebral Palsy / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular / Q000009:adverse effects* / Q000379:methods; D008012:Lidocaine / Q000627:therapeutic use*; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D009609:Nitrous Oxide / Q000627:therapeutic use*; D010102:Oxygen Inhalation Therapy; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods; D011318:Prilocaine / Q000627:therapeutic use*; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000777:Anesthetics; D018726:Anti-Dyskinesia Agents; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D008012:Lidocaine; D001905:Botulinum Toxins; D009609:Nitrous Oxide