Abstract
ObjectiveTo determine the methods of anesthesia currently being used by pediatric rheumatologists when performing intra-articular corticosteroid injections (IACI).Study designA questionnaire was emailed to all members of the Childhood Arthritis & Rheumatology Research Alliance, a pediatric rheumatology research network in North America. The questionnaire consisted of 11 questions ranging from procedure technique, treatments prescribed for topical anesthesia and oral analgesia, and factors that might affect procedural pain.ResultsSeventy-four of 161 physicians (46%) responded to the questionnaire. On average, each physician injected 33 children (median 25, range 1-160) and 43 joints (median 30, range 1-150) yearly. Local anesthesia was used in children on average ≥ 8 years (range 2-16 years), with general anesthesia being more frequently used for younger children. All respondents used local anesthesia. The most commonly used methods of local anesthesia were EMLA® cream plus subcutaneous lidocaine (58.8%), ethyl chloride spray only (39.7%), EMLA® cream only (33.8%), subcutaneous lidocaine only (25%), and lidocaine iontophoresis only (11.8%). Buffering of the lidocaine was routinely done only 7.4% of the time.ConclusionAlthough pediatric rheumatologists in North America perform IACI on a large number of patients each year, a wide variety of methods are used to deliver local anesthesia with no accepted standard of care. More studies are needed to determine the optimal method of local anesthesia delivery to minimize pain associated with IACI.
Highlights
Intra-articular corticosteroid injections (IACI) are one of the mainstays of treatment for children with chronic arthritis [1,2,3,4,5,6,7]
IACI is most frequently used for children with oligoarticular juvenile idiopathic arthritis
Members of the Childhood Arthritis & Rheumatology Research Alliance (CARRA), a research network of all academic pediatric rheumatology centers in North America, received an 11 question self-administered, free response and multiple choice questionnaire between April and June 2005 either by email or distribution at the annual CARRA meeting inquiring about anesthesia for subjects receiving IACI
Summary
Intra-articular corticosteroid injections (IACI) are one of the mainstays of treatment for children with chronic arthritis [1,2,3,4,5,6,7]. IACI enables the physician to deliver localized treatment and may obviate the need for systemic medication or serve as an adjunct to systemic medications [1,2,4]. Another advantage is the rapidity of response to the IACI, which usually occurs within a few days of the injection [4]. IACI is most frequently used for children with oligoarticular juvenile idiopathic arthritis. In one survey looking at the use of IACI for treatment of juvenile idiopathic arthritis, 43% of respondents regarded pain of procedure as a disadvantage to IACI therapy [7]. Despite the frequent use of IACI by pediatric rheumatologists, there have been no studies performed to evaluate the relative efficacy of different methods of anesthesia, and there seems to be no widely accepted standard of care for the provision of anesthesia in IACI
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
