• Stefan Nilsson, Ingemar Brunsson, Berit Askljung, Magnus Påhlman, and Kate Himmelmann.
• Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
• Acta Paediatr. 2017 Mar 1; 106 (3): 458-462.

AimThe aim of this study was to investigate how effective a combination of rectally administered midazolam and racemic ketamine was for reducing pain in paediatric cerebral palsy patients receiving intramuscular injections of botulinum neurotoxin A. The feasibility and safety of the pain relief were also explored.MethodChildren with cerebral palsy, aged one to 18 years, were recruited from a regional paediatric rehabilitation unit between April 2012 and May 2014. Pain intensity, feasibility, total time spent in the clinic and side effects were registered. Pain scores were recorded by parents and healthcare professionals using different pain scales.ResultsWe recorded 128 procedures in 61 children. The median scores were two (range: 0-10) for pain intensity and nine (range: 0-10) for feasibility. The median treatment time in the outpatient unit was 3.25 hours, and the most common side effects were nausea, pain and sleep disturbance. Gross motor function levels showed a negative correlation with the pain scores. This method could be an alternative to nitrous oxide/oxygen mixture for patients who do not tolerate inhalation analgesia.ConclusionRectally administered midazolam and racemic ketamine provided effective pain relief for paediatric cerebral palsy outpatients receiving painful injections and was a viable alternative to inhalation analgesia.©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

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