Intranasal Dexmedetomidine Sedation During Intra-articular Joint Injections in Pediatric Population

The main objective of this study is to evaluate the effectivity of intranasal dexmedetomidine sedation during intra-articular injection therapy. Intranasal dexmedetomidine is compared with dinitrous oxide (N2O) which has already been proven safe and effective sedation method during painful procedures in pediatric patients. In earlier studies the median VAS during intra-articular corticosteroid injections with patients receiving nitrous oxide has been 3 (Uziel et al 2008). Study hypothesis is that with intranasal dexmedetomidine sedation the VAS pain levels will be 1 unit lower.

sedation, pediatrics, intranasal sedation, dexmedetomidine, dinitrous oxide, intra-articular joint injection

Dexmedetomidine is given once 4 micrograms per kilogram intranasally. If the sedation is not successful another 2 microgram per kilogram intranasal dose is given. Intravenous dexmedetomidine solution is administrated intranasally with MAD nasal drug delivery device and a syringe.

Dinitrousoxide (N2O) is given with Livopan administrating device. Livopan consists of 50% oxygen and 50% nitrous oxide. Gas mixture is inhaled 5 minutes before the injection procedure and during the injection procedure.

Intranasal administration of dexmedetomidine as a procedural sedation (intra-articular joint injection)

The VAS score is assessed after procedure when the patients have recovered from the sedation and are being discharged. The time of discharge is 1 to 5 hours after the injection procedure.

Assessed in every 5 minutes 20 minutes before the drug administration and for six hours after the drug administration.

Assessed in every 5 minutes 20 minutes before the drug administration and for six hours after the drug administration.

Assessed in every 5 minutes 20 minutes before the drug administration and for six hours after the drug administration.

Assessed in every 5 minutes 20 minutes before the drug administration and for six hours after the drug administration.

The Face, Legs, Activity, Cry, Consolability scale or FLACC scale is a measurement used to assess pain for children

Before the injection procedure, during the injection procedure, 5 and 10 minutes after the procedure and when the patient is being discharged.

Assessed 20 minutes before the drug administration and in every 15 minutes for six hours after the drug administration and during the injection procedure and 5 and 10 minutes after the injection.

Assessed continuously 20 minutes before the drug administration and for six hours after the drug administration.

Oxygen saturation by pulse oxymetry is measured continuously 20 minutes before the drug administration and for six hours after the drug administration.

Inclusion Criteria: Patient age between ages 1year to 18 years A joint inflammation in 1-5 joints needing intra-articular corticosteroid injection diagnosed by pediatric rheumatologist Exclusion Criteria: Patients under the age of 1year and over the age of 18years are excluded as well as patients needing injection therapy to more than 5 joints.