# Procedural pain and sedation for children with cancer: needles, lumbar punctures and marrow tests

Source: https://onco.cc/protocols/paediatric-procedural-pain-and-sedation/  
OnCo record `paediatric-procedural-pain-and-sedation` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Children with cancer have many needles, lumbar punctures and bone marrow tests. An international guideline says every needle procedure should use numbing cream and distraction, and every child having a lumbar puncture should be offered deep sedation or a general anaesthetic. Sedation is given by a trained team with monitoring, after the child and family are prepared for what will happen.

## Summary

The international clinical practice guideline on needle procedures in children with cancer (Loeffen et al., Eur J Cancer 2020; GRADE, 48 randomised trials, 2,271 participants, evidence very low to moderate) makes strong recommendations for topical anaesthetics in all needle procedures, for offering deep sedation or general anaesthesia to all children undergoing lumbar puncture, for deep sedation or general anaesthesia in major procedures in children of all ages, and for hypnosis and active distraction in all needle procedures. NICE CG112 (sedation in under 19s) sets the safety frame: trained pre-sedation assessment and documented consent, psychological preparation suited to the child's development, parents offered the chance to be present, a team with life support skills (advanced life support for deep sedation), an anaesthetist available for propofol, sevoflurane or opioids with ketamine, continuous monitoring including capnography for deep sedation, and discharge criteria. Fasting is not needed for minimal sedation, nitrous oxide or moderate sedation with verbal contact; for deeper sedation professional fasting guidance applies, with the 2018 move to 1 hour for clear fluids. For painful procedures NICE suggests considering a local anaesthetic as well as a sedative.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: sedation for lumbar puncture in children; general anaesthetic for LP; needle pain in children with cancer; numbing cream before port access; procedural distress paediatric oncology; bone marrow aspirate sedation
- Tags: protocol; paediatric; procedural-pain; sedation

## Connected records

- protocols: [Hand hygiene in cancer care: staff, patients, families and visitors](https://onco.cc/protocols/hand-hygiene-in-cancer-care/), [Implanted port access, flushing and care in adults having cancer treatment](https://onco.cc/protocols/implanted-port-access-and-care/)
- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Childhood cancers (all types)](https://onco.cc/cancers/childhood-cancers/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Implanted ports for chemotherapy (port-a-cath, power-injectable, apheresis and intraperitoneal ports)](https://onco.cc/technologies/implanted-ports/)
- companies: [Children's Oncology Group (COG)](https://onco.cc/companies/childrens-oncology-group/)
- institutions: [National Institute for Health and Care Excellence](https://onco.cc/institutions/nice/), [World Health Organization Cancer Programme](https://onco.cc/institutions/who/)
- terms: [Intrathecal therapy (lumbar puncture, Ommaya reservoir)](https://onco.cc/terms/intrathecal-therapy/)

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