BMJ  2003;327:681 (20 September), doi:10.1136/bmj.327.7416.681

Letter

Managing chronic pain in children and adolescents

Procedural sedation should be considered

The first 150 words of the full text of this article appear below.

EDITOR—Eccleston and Malleson point out the "vacuum" of treatment for pain in children during the time required for diagnosis.1 This lack of attention to pain exists also for children with chronic disorders (such as inflammatory bowel disease, cancer, and rheumatoid arthritis) that often require repeated painful procedures (colonoscopy, lumbar puncture, bone marrow aspiration, arthrocentesis).

The need to perform sedation in children in this setting has increased notably, and deep sedation is required to achieve anxiolysis and immobilisation necessary for painful procedures.2 Nevertheless, deep sedation is not routinely offered to children. In Italy no formal guidelines recommend deep sedation for oncological procedures and only the last guidelines of the Italian Society of Pediatric Gastroenterology recommend sedation for endoscopies.3

The lack of availability of anaesthesia resources, the risk of oversedation, and decrease in level of cardiorespiratory function limit the widespread use of this practice. Trials are ongoing to clarify the . . . [Full text of this article]

Egidio Barbi, clinical paediatrician

ebarbi@libero.it

Tania Gerarduzzi, resident in paediatrics, Federico Marchetti, clinical paediatrician

Clinica Pediatrica, IRCCS Burlo Garofolo, Università di Trieste, Via dell'Istria 65/1, Trieste, Italy


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