title: A rectally administered combination of midazolam and ketamine was easy, effective and feasible for procedural pain in children with cerebral palsy.
abstract: OBJECTIVE
  The aim of this study was to investigate how effective a combination of rectally administered midazolam and racemic ketamine was for reducing pain in paediatric cerebral palsy patients receiving intramuscular injections of botulinum neurotoxin A. The feasibility and safety of the pain relief were also explored.
  
  
  METHODS
  Children with cerebral palsy, aged one to 18 years, were recruited from a regional paediatric rehabilitation unit between April 2012 and May 2014. Pain intensity, feasibility, total time spent in the clinic and side effects were registered. Pain scores were recorded by parents and healthcare professionals using different pain scales.
  
  
  RESULTS
  We recorded 128 procedures in 61 children. The median scores were two (range: 0-10) for pain intensity and nine (range: 0-10) for feasibility. The median treatment time in the outpatient unit was 3.25 hours, and the most common side effects were nausea, pain and sleep disturbance. Gross motor function levels showed a negative correlation with the pain scores. This method could be an alternative to nitrous oxide/oxygen mixture for patients who do not tolerate inhalation analgesia.
  
  
  CONCLUSIONS
  Rectally administered midazolam and racemic ketamine provided effective pain relief for paediatric cerebral palsy outpatients receiving painful injections and was a viable alternative to inhalation analgesia.
authors.affiliation: Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Nilsson
authors.affiliation: Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Ingemar
authors.initials: I
authors.lastname: Brunsson
authors.affiliation: Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Berit
authors.initials: B
authors.lastname: Askljung
authors.affiliation: Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Påhlman
authors.affiliation: Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Kate
authors.initials: K
authors.lastname: Himmelmann
mesh_terms: D000285:Administration, Rectal; D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage; D002547:Cerebral Palsy; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007223:Infant; D007273:Injections, Intramuscular / Q000009:adverse effects; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D009465:Neuromuscular Agents / Q000008:administration & dosage; D000073818:Procedural Pain / Q000209:etiology / Q000517:prevention & control*
chemical_list: D006993:Hypnotics and Sedatives; D009465:Neuromuscular Agents; D007649:Ketamine; D019274:Botulinum Toxins, Type A; D008874:Midazolam
keywords: Botulinum neurotoxin A; Cerebral palsy; Ketamine; Midazolam; Rectal administration