University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Oncology/Hematology, Groningen, the Netherlands.
Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
Eur J Cancer. 2020 May;131:53-67. doi: 10.1016/j.ejca.2020.02.039. Epub 2020 Apr 14.
Children with cancer often undergo long treatment trajectories involving repeated needle procedures that potentially cause pain and distress. As part of a comprehensive effort to develop clinical practice guidelines (CPGs) to address pain prevention and management in children with cancer, we aimed to provide recommendations on the pharmacological and psychological management of procedure-related pain and distress.
Of the international inter-disciplinary CPG development panel (44 individuals), two working groups including 13 healthcare professionals focused on procedural pain and distress. Grading of Recommendations Assessment, Development and Evaluation methodology was used, including the use of systematic literature reviews to inform recommendations and the use of evidence to decision frameworks. At an in-person meeting in February 2018, the guideline panel discussed these frameworks and formulated recommendations which were then discussed with a patient-parent panel consisting of 4 survivors and 5 parents.
The systematic reviews led to the inclusion of 48 randomised controlled trials (total number of participants = 2271). Quality of evidence supporting the recommendations ranged from very low to moderate. Strong recommendations were made for the use of topical anesthetics in all needle procedures, for offering deep sedation (DS)/general anesthesia (GA) to all children undergoing lumbar puncture, for the use of DS/ GA in major procedures in children of all ages, for the use of hypnosis in all needle procedures and for the use of active distraction in all needle procedures.
In this CPG, an evidence-based approach to manage procedure-related pain and distress in children with cancer is presented. As children with cancer often undergo repeated needle procedures during treatment, prevention and alleviation of procedure-related pain and distress is of the utmost importance to increase quality of life in these children and their families.
癌症患儿通常需要接受长期的治疗，包括多次可能引起疼痛和不适的有创性操作。作为制定全面的癌症患儿疼痛预防和管理临床实践指南（CPGs）的一部分，我们旨在提供与操作相关的疼痛和痛苦的药物和心理管理建议。
在国际跨学科 CPG 开发小组（44 人）中，有两个工作组包括 13 名医疗保健专业人员，重点关注操作性疼痛和痛苦。使用推荐评估、制定和评估（GRADE）方法，包括系统文献回顾以提供建议，并使用证据决策框架。在 2018 年 2 月的一次现场会议上，指南小组讨论了这些框架，并制定了建议，然后与由 4 名幸存者和 5 名父母组成的患者-家长小组进行了讨论。
系统审查导致纳入了 48 项随机对照试验（总参与者人数=2271）。支持建议的证据质量从极低到中等不等。强烈建议在所有有创性操作中使用局部麻醉剂，对所有接受腰椎穿刺的儿童提供深度镇静（DS）/全身麻醉（GA），对所有年龄段的儿童进行大手术时使用 DS/GA，在所有有创性操作中使用催眠，并在所有有创性操作中使用主动分散注意力。
在本 CPG 中，提出了一种基于证据的方法来管理癌症患儿的操作性疼痛和痛苦。由于癌症患儿在治疗过程中经常进行多次有创性操作，因此预防和缓解操作相关的疼痛和痛苦对于提高这些儿童及其家庭的生活质量至关重要。
