Douleurs Chroniques et Anesthesie Loco-Régionale chez l'Enfant. [Chronic pain and regional anesthesia in children.]
Résumé
Chronic pain is usually underestimated in children, due to lack of knowledge and to its specific semiotic. In addition to suffering, chronic pain causes a physical, psychological, emotional, social and financial burden for the child and his family. The practitioners may find themselves in a situation of failure with depletion of medical resources. Some types of chronic pain are refractory to conventional systemic treatment and may require the use of regional anesthesia. Cancer pain is common in children and its medical management is sometimes insufficient. It is accessible to neuroaxial or peripheral techniques of regional anesthesia if it is limited to an area accessible to one of those techniques and no contraindications (e.g., thrombopenia) are present. Complex regional pain syndrome 1 is not rare in children and adolescents but it is often undiagnosed. Regional anesthesia may contribute to the treatment of complex regional pain syndrome 1, mainly in case of recurrence, because it provides rapid effective analgesia and allows rapid implementation of intensive physiotherapy. These techniques have also shown interest in the phantom limb pain after limb amputation, but remain controversial for erythromelalgia pain or chronic abdominopelvic pain. Finally, the treatment of post-dural puncture headache due to cerebrospinal fluid leak can be treated by performing an epidural injection of patient's blood, called "blood patch". Last but not least, the management of children with chronic pain should be multidisciplinary (pediatrician, physiotherapist, psychologist, surgeon, anesthesiologist) to support the child and his problem in its globality.
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Pédiatrie
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