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Pain Research and Management
Volume 5, Issue 2, Pages 141-147
Pediatric Pain Management

Intravenous Sedation for Control of Distress during Lumbar Punctures for Pediatric Cancer Patients

Jacqueline Ellis,1 Patricia McCarthy,2 Pierre Gosselin,1 and William Splinter2

1University of Ottawa, Ottawa, Ontario, Canada
2Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada

Copyright © 2000 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


OBJECTIVE: To compare the sedative and amnestic effects, the rapidity of recovery, and the adverse effects of midazolam and propofol for intravenous sedation. The focus of this paper is the effects of intravenous sedation on distress, the acceptability to parents of this intervention for helping their children cope with painful procedures and the utility of an intravenous sedation program administered by an anesthetist.

PATIENTS AND METHODS: Twenty six children were randomly assigned to intravenous sedation with either midazolam or propofol as the first drug received. Self-report measures of  anxiety and fear were assessed before and 30 min after the lumbar puncture (LP). Self-report of pain was also assessed 30 min post-LP. The children were videotaped during the LP, and the tapes were coded for pain and negative emotion using the Emotion Facial Action Coding System. One parent completed the acceptability questionnaire while the child was in the recovery room.

RESULTS: Only three children indicated pain on the Visual Analogue Scale, and two children had facial expressions indicative of pain during the LP. Fear and anxiety differed as a function of procedure order, and children were more fearful and anxious before the first sedated LP than the second. Intravenous sedation was highly  acceptable to parents, and neither drug was considered superior.

CONCLUSIONS: Intravenous sedation with either propofol or midazolam, in combination with analgesia, was effective for alleviating pain and emotional distress associated with LPs. Although children were told that the sedation would make them relaxed and sleepy, they remained somewhat fearful until they experienced a comfortable LP. The benefits of an anesthetist-administered intravenous sedation program are discussed.